Loan Application Current Customer Loan Application Complete Customer Type Individual Limited Company Cooperative/Association Individual Full Name Phone Number Email Date of Birth Nationality - None - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Ceuta & Melilla Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo - Brazzaville Congo - Kinshasa Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d’Ivoire Denmark Diego Garcia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR China Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea North Macedonia Norway Oman Outlying Oceania Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Samoa San Marino Sark Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Barthélemy St. Helena St. Kitts & Nevis St. Lucia St. Martin St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Sweden Switzerland Syria São Tomé & Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkmenistan Turks & Caicos Islands Tuvalu Türkiye U.S. Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Gender - None - Male Female Marital Status - None - Single Married Divorced Widow/Widower Mobile Number Physical address Region District Ward Village/Street Fax Value Chain - None - Distribution Input Marketing Processing Production Storage Number of Acres Type of Product/Activity - None - Animal husbandry Asset Crop farming Fish farming Forestry Infrastructure Other Poultry Expected loan Limited Company Customer Full Name Date of Registration Country of Registration - None - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Ceuta & Melilla Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo - Brazzaville Congo - Kinshasa Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d’Ivoire Denmark Diego Garcia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR China Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea North Macedonia Norway Oman Outlying Oceania Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Samoa San Marino Sark Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Barthélemy St. Helena St. Kitts & Nevis St. Lucia St. Martin St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Sweden Switzerland Syria São Tomé & Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkmenistan Turks & Caicos Islands Tuvalu Türkiye U.S. Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Contact person/Managing Director Number of employees Male Employees Female Employees Company Phone Number Physical address Region District Ward Village/Street Postal Address Company Email Website Link URL Company Fax Value Chain - None - Distribution Input Marketing Processing Production Storage Number of acres Type of Products - None - Animal husbandry Asset Crop farming Fish farming Forestry Infrastructure Other Poultry Cooperative/Associaltion Cooperative Society/Association Full Name Date of Registration Assistant registrar of cooperatives Region Full Name Phone Number Email Address Contact Person/Chairperson Contact Person Full Name Contact Person Mobile Number Number of members Male Members Female Members Number of beneficiaries Male beneficiaries Female beneficiaries Mobile number Email Address Postal Address Website Link URL Fax Value Chain - None - Distribution Input Marketing Processing Production Storage Number of acres Type of product/activity - None - Animal husbandry Asset Crop farming Fish farming Forestry Infrastructure Other Poultry Physical Address Region District Ward Village/Street Leave this field blank
