HIRE PURCHASE APPLICATION FORM

HIRE PURCHASE APPLICATION FORM
Are you an existing or new customer*

ExistingNew
What is your Primary Financial Institution*
Name of the Financial Institution*
Provide your DTB account number*
Select the type of hire purchase you require*

Applicant's Details
Applicant's Name*

First NameMiddle NameLast Name
Nationality
ID Number/ Military Number*
Passport*
Alien Card/ Foreign Certificate
(For Foreigner Resident)
KRA PIN*
Mobile Number*
Please enter a valid phone number.
Alternative Mobile Number
Please enter a valid phone number.
Email Address*
example@example.com
Physical Address*
Postal Address

Nature of Business
Source of Income*
Profession/Designation*
Name of Employer*
Employer's Physical Address*
Employer's Postal Address
Name of the Business*
Nature of the Business*
Description of the Business*
Physical Address of the Business*
Postal Address of the Business
Is the Business Registered*
Date of Registration*

DayMonthYear
Date
Business Registration Number*
Average Monthly Turnovers*

Business Details
Name of the Business/Company*
Business/Company KRA PIN*
Date of Registration/Incorporation*

DayMonthYear
Date
Registration Number*
Business/Company Email Address*
example@example.com
Board Activity*
Business/Company Physical Address*
Company/Business Postal Address
Nature of the Business
Description of the Business*
Applicant's Name*

First NameLast Name
Applicant's Phone Number*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Average Monthly Turnovers*

Vehicle/Equipment to be financed
Is the Vehicle being purchased used or new*
Selling Price of the Vehicle*
Deposit Amount*
Loan Amount to be Financed
Interest Rate
Interest Rate is subject to approval
Repayment Period (Months)*
Monthly Repayment
Monthly Int Rate
Would you like us to arrange for Insurance Premium Financing for the vehicle*
Power
One
maths..
power-1
MI*Power
Year

ATTACHMENTS
ID/Military Card/Passport*

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Pin Certificate*

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Director 1 ID*

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Director 2 ID*

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Director 1 Pin Certificate*

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Director 2 Pin Certificate*

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Proforma Invoice/Sales Agreement*

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3 months payslips*

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Copy of Logbook*

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Latest certified 6 months Bank Statements*

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Business Registration Documents*

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Certificate of Incorporation/Registration*

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Company Pin Certificate*

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CR 12/Annual Returns*

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Memorandum & Articles of Association

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Latest Audited Financial Statements

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Signature*

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Should be Empty: