ACHIVERS MULTIPURPOSE INVESTMENT LIMITED

Government office. 13th Floor, East wing, 30 simmonds st.

Motto: “..people success is our priority”
+27- 664608820

PART A
(TYPE) …..…MONTHLY …… Loan Application Form
(Please fill in with Capital letter )

Town: ------------------ State: ----------------Date of Application: -------------------

PERSONAL INFORMATION OF THE APPLICANT
1. Name: ……………………………………………………………………..
2. Name of father / Husband: ………………………………………………...
3. Residential Address:……………………………………………………….
4. Permanent Address:……………………………………………………..…
5. Business Address:………………………………………………………….
6. Phone No:……………………………………………………………..…...
7. Age:………………………………………………………………………..
8. Marital status: Single Married Divorced widow
9. Formal education: None Primary school Secondary Tertiary
10.Next of kin (name and phone No):…………………………………
BUSINESS INFORMATION OF APPLICATION
1. Name of the Group :----------------------------------------------------------------
2. Date of Membership:---------------------------------------------------------------
3. Type of Business:-------------------------------------------------------------------
4. Loan Applied for ( principle amount) R-----------------------------------------
5. Amount approved R......................... No of Installment-----------------------
6. Loan Duration…………………………………
7. Any family member of yours registered with present Group: Yes No
…….. (if yes, mention name………..), or registration in any other
existing group of ACHIVERS Yes NO
8. Amount of saving in passbook R .................................................................
9. How long is this business:……………………………………………….
10.Average monthly business R........................................................................
11.Name of bankers/ Account number:……………………………………….

DECLARATION
I, …………............. Husband/ wife of ……………village/town:……………….
State ………………… hereby signed this declaration voluntarily and in good
faith on the…………. Day of ………….. Month …………… Year.
This declaration will also be applicable to my heirs, caretaker, nomination
representative and other people concerned. ACHIVERS has approved a loan of
R……………. to me with serve charge 20% is fully repaid, ACHIVERS will
have total control of all my family assets. I will abide by all the conditions
herein stated and will repay the entire loan, regardless of the physical conditions
of the assets acquired by this loan. If I fail to repay the loan, ACHIVERS is free
to recover the entire outstanding loan, naming and shaming in public places and
taking legal action against me. My heirs or I will have no objection to such
action and if raised will not be valid in court of law. I sign the declaration fully
aware of the consequences in full mind and conscience.

Name ………….. ……….. Signature of applicant………………

PART B
Business Informationp of Applicant
Name of Guarantor………………………………………………......................
Relationship with Borrower---------------------------------------------------------------
Guarantor’s Address……………………………………………………………...
Guarantor’s office Address………………………………………………………
Occupation……………………………………………………………………......

DECLARATION
I ………… , guarantor/……………. (Relationship with loanee) to…….............
(Name of loanee) from …………… village/town in ………. Town
……………….state. Hereby sign this declaration voluntarily and in good faith
on this ……… Day of ……….. Month ………… year.
As guarantor to ……… (loanee), I hereby declare as follows: To ensure that the
loaneee offsets his/her loan with ACHIVERS, to produce the loanee whenever
required, and to corporate with ACHIVERS in this accord.
I further declare that I should be held responsible if the loanee defaults in
payment and to equally bear the cost of offsetting the loan as a result of such
default by loanee. if for any reason I fail to perform my obligation as a
guarantor to loanees, ACHIVERS is free to take legal action against me or any
means of necessary to recover the loan.
Guarantor’s Phone no: ……………. Guarantor’s signature……………

Approved by BM………………… ……………………….

(Name) (signature)

…………………………….
DATE