Beruflich Dokumente
Kultur Dokumente
PLEASE COMPLETE THIS FORM IN BLOCK LETTERS. All blanks must be completed. Use N/A if blank is not
applicable. If more than one borrower attach details of other borrowers on separate sheet of paper
BORROWERS PERSONAL DETAILS
Surname
First Name
Middle Name
CHITAYI
NIMROD
MUSUNGU
In the event that are not successful can Family Bank/ Kenya ICT Board share your plan with partners who
are interested in providing funding? No Yes
DECLARATION
I/We declare that all the information given herein and attached is true to the best of my/our knowledge
and belief: I/We further authorize Family Bank Ltd. to verify the information given herein and make
reference from any person(s)/institution(s) named herein or on the attached documents
I/We also authorize you to obtain any information you may require relating to this application from my
employers, if any and from any other source to which you may apply, each source hereby authorized by
me/us to provide you with such information.
I/We undertake to notify Family Bank Ltd immediately of any situation which materially changes the
representation of this application. I/We hereby authorize Family Bank Ltd. to disclose any and all
information in respect of my account to Kenya ICT Board, for as long as my/our debt to Family bank is
outstanding.
I/We confirm that I/We am/are in good health and accept and agree to be bound by the terms and
conditions as will be contained in the Pasha loan Terms and conditions
NAME
SIGNATURE
DATE dd/mm/year
_______________________________________________Credit Officer
Signature: __________________________
Name:
Date____/____/________
_______________________________________________Manager
Signature: __________________________
Date____/____/________
Date of Commencement
MM/DD/YYYY
Physical Location
Tick as appropriate:
(a) new business
(b) takeover
(c) expansion
Other (please specify)
(When business started or proposed date for starting it)
APRIL 2ND 2011
(d) Air
Tick as appropriate:
(a) Sole
Proprietor
(d) Other specify:
(b) Partnership
To provide the Bamburi community with quality brand-name Information Technology services,
business information solutions, reliable and professional Technical Support, and unparalleled
Customer Service through quality service delivery and to earn a fair profit for our centre by
embracing sound, ethical business practices.
Overall Objective
To make Instant Pasha Centre an environment that will bring people with diverse
interests and backgrounds together in a common forum.
1
2
3
4
Service Objectives
(Quality of Service)
Profit Objectives
(Provide actual %
and amount
targets)
Growth Objectives
Social Objectives
(Value and
contributions to
the nearby
community)
Weaknesses
Opportunities
Threats
Quantity
Description
Toshiba
Dell
Training
Comps
Dell
Server
Dell
Mitsumi
Printer
HP
Spaceman
Printer
HP
Scanner
HP
Photocopy
machine
Binding
Machine
Fuji
Bestell
6,630
6,630
Laminator
Fuji
Bestell
7,140
7,140
Paper
Cutter
Bestell
2,300
2,300
Spirals
14
Bestell
14
280
3,920
Bestell
118
236
Office
Laptop
Cyber
Comps
ID
Laminatin
g pouches
Manufacturer
2 Packets
5
Supplier
Unit
Unit
Cost
(KES)
Total
Cost
(KES)
Bestell
1
41,900
41,900
18,000
126,000
16,000
96,000
45,000
45,000
Spaceman
3,500
7,000
Bestell
6,300
6,300
Labos Tech
Labos Tech
120,000
A4
laminating
pouches
2 Packets
Bestell
122
244
Web cams
Creative
Spaceman
1,000
8,000
Headsets
Creative
Spaceman
800
6,400
Projector
Sony
Labos Tech
43,700
43,700
Switch
D-LINK
Spaceman
4,896
4,896
Router
D-LINK
Spaceman
4,500
4,500
Sony
Nakumatt
15,000
15,000
Mercury
Bestell
12
2,400
28,800
Lecol
35,000
35,000
Digital
camera
UPS
12
Air
Condition
Camcorder
Sony
Nakumatt
35,000
35,000
Spaceman
6,630
6,630
HP
Bestell
20,000
20,000
Technical
comp
Acer
Capital
Software
34,000
34,000
Chairs
25
Fairdeal
furniture
Fairdeal
Furniture
25
1,500
37,500
Original
Windows
Software
18
Microsoft XP
Bestell
18
12,000
216,000
Microsoft
office
student(3
user)
Microsoft Office
Bestell
4,300
25,800
Computer
Tables
13
Fairdeal
Fairdeal
furniture
13
4,500
58,500
Counters
Fairdeal
Fairdeal
15,000
30,000
50,000
50,000
Electric
Blower
Digital
Photo
printer
Other
facilities
Total
1,122,396
Source
Cost (KES)
1000
18,000
5800
1250
Free
PIN number
By-laws
Employment Act / Labour Laws
Tax Schedule / Reports
Environmental, Health & Safety
Regulations
Patents & Copyrights
K.R.A
Free
Municipal council
250
Ministry of Labour
200
K.R.A
Free
Free
Owners
Free
Monthly Salary/Wages
(KES)
18,000
10,000
8000
8000
7000
6000
1
1
1
1
1
1
Monthly Costs
(KES)
30,000
57,000
5000
2000
3000
3000
4000
4000
3000
1153
500
2088
3000
117,741
Rent
Wages & Salaries
Electricity
Telephone
Transport
Stationary
Advertising
Repairs & Maintenance
Taxes
Insurance
Bank Charges
Legal Fees
Licenses & Permits
Any Other Expenses
Total
Annual Total
(KES)
216,000
120,000
96,000
96,000
84,000
72,000
Annual Cost
(KES)
360,000
684,000
60,000
24,000
36,000
36,000
48,000
48,000
36,000
14000
6000
25050
36000
1,412,892
By Whom?
When?
Monthly Fees
(KES)
500
3000
4000
Annual Cost
(KES)
6000
36000
48000
7500
90,000
Success Indicator
Cost
(KES)
2,553,000
1,122,396
200,000
25,050
65,000
20,000
70,000
3000
1,505,446
1,047,554
7.2 Pre-operational Costs (costs before start-up)- to be filled by start ups ONLY
Instant Pasha Centre
Pre-Operational Costs
Item
Land, Building & Construction Lease
Renovations
Equipment
Electricity
Security, e.g., watchmen, alarm system
Water
Telephone & Postage
Survey Fees
Legal Fees
Registration Fees
Licenses & Permits
Patents & Copyrights
Rent
Furniture, Fixtures & Fittings
Installation, e.g., networks, switches
Stationary
Stock of retail, material goods
Reproduction of documents
Wages & Salaries
Staff Training
Bank Charges
Transport
Insurance
Advertising
Other Expenses
Cost (KES)
40,000
1,122,396
5,000
20,000
1,000
6,000
1,300
25,050
90,000
176,000
Total
10
Year 1
Amount (KES)
Year 2
Year 3
Total
B. Current Liabilities
Short-term Loan
Bills Payable
Creditors
Total
A B = Working Capital Total
7.4 Revenue (Cash sales) Projections
[Show projections and justification for each product & Service Line to be offered. Be realistic in the rate of
build up from year 1 to year 2, and Future Growth]
Totals
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Year 1
Amount (KES)
Year 2
FINANCIAL DETAILS
4.1 Bank Accounts: kindly provide details of all bank accounts held (Please provide 6 months Account
statements for all accounts listed)
ACCOUNT TYPE
BANK
SAVINGS
NATIONAL BANK OF KENYA
BRANCH
PORTWAY HOUSE
ACCOUNT NUMBER
0124597117800
Credit History
Do you have any credit facility from any other bank or institutions? Yes No
If the answer is yes please provide details on each and provide copies of repayment receipts/ or loan
statements for the last 3 payments.
1
Type of Loan
Name of Lender
Date Loan Paid-off/ to be Paid -off
Loan Amount Disbursed
Amount Outstanding
Monthly Instalment Amount
Number of payments made on
time
Number of payments paid late
Security Held
Do you plan on borrowing any money from any organization during the tenure of the loan been currently
applied for? Yes No If yes, please provide terms and purpose.
Are you a guarantor for any other loans not listed above? Yes / No
If yes, please provide full details.
Kindly list all significant personal assets owned and any liabilities against them,
SECTION 9: REFERENCES
Please provide the details of 3 (three) non-family referees below:
Full Names: ___________________________________________________________________________
Relationship:________________________________________ Occupation: ________________________
P.O. Box ___________________Code______________ Town: _________________________
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Telephone Numbers
Mobile: ______________________/_____________________/_____________________
Office:
______________________/_____________________Residential:_____________________
______________________/_____________________Residential:_____________________
______________________/_____________________Residential:_____________________
13