I&M UNSECURED PERSONAL CHECK OFF LOAN APPLICATION FORM
Sales code Originator branch
Customer CIF Account no.
A. Applicant details
Mr/Mrs/Ms First name Middle name Surname
Date of birth Gender: Male Female
National ID/PP no. KRA PIN
Residence Resident County Non-resident State /country name
Mobile 1 Mobile 2 Telephone (work)
Email address 1 Email address 2
Residential/physical address Estate House no. Town/ city
Number of years at this address month (if less than 2 years): previous address
Residential status: Owned Rented Mortgage Company provided Other (please specify)
Marital status: Number of dependents
B. Alternative contact person
Name Phone no Email address Relationship
C. Loan application details
Loan amount applied for: (in figures) (in words)
Repayment method Direct debit Check off
Tenure: Months Repayment amount
Interest rate p.a % Loan processing fees % Loan buy off / balance transfer: KShs
Purpose for loan: (specify)
Loan type New loan Top up Take over
D. Credit card details
Do you have a credit card? Yes No
Name of card provider Card number Expiry date Limit
1.
2.
Do you wish to apply for an I&M Bank credit card? Yes No
Do you wish get a supplementary credit card? Yes No . If yes, please fill an overleaf form.
Amount applied for: (in figures) (in words)
AUTO-DEBIT INSTRUCTIONS (optional, to be filled by I&M Bank account holders)
I hereby authorise you to debit my account no with I&M Bank for payment of % of the billed amount
on the respective due dates without requiring you to give me notice prior to debiting the account (applicable card minimum % applies)
Where would you like the card delivered? Delivery by courier Branch (branch name)
Note that card statement will be sent to the email address provided by the customer in this application form.
E. Employment details / business details
Employment status:
Employed Employer Work address Pensioner
Emloyment type Permanent Contract Part-time
Employment date D D M M Y Y Y Y Contract expiry date D D M M Y Y Y Y Contract tenure
Position Occupation Net monthly salary
Other income (where applicable) Duration at current organisation
Previous employer (if less than 12 months with current employer)
Period employed: years/month
F. Existing loan payments
Bank /branch Account number Principal loan Outstanding balance
1.
2.
G. Declaration,terms & conditions (T&Cs)
1. In the event that the amount I qualify for is less than the amount requested, I instruct the Bank to contact me before crediting my account.
2. I authorise the Bank to create a loan account in my name and disburse the approved amount without reference to me.
3. As credit life cover is mandatory for this loan, I hereby authorise I&M Bank Limited to arrange credit life cover to settle the outstanding balance on my personal
loan account in the event of my death and/or permanent disability and retrenchment. I authorise I&M to debit my account with the life insurance premiums.
4. I understand that any granted cover will be subject to the provisions of the master policy whose details are available for inspection at I&M Bancassurance.
5. I hereby agree to select an insurance underwriter from the Bank’s insurance agents’ approved panel of licensed insurance underwriters. By doing so, the borrower
waives the right to select underwriter or broker except for those on the Bank’s panel. I hereby declare that a list of alternative insurance underwriters have been
provided to me, that the policy remains in force for the duration of the loan. Should the policy be cancelled at any stage during the period of the loan I authorise
the Bank to arrange the required cover on my behalf and debit my account with the relevant premiums.
6. I confirm that the details provided in this form and in any attached documents are a true reflection of my personal, employment and other details. In addition to
accepting this loan offer, I agree that the loan will be fully repayable if I move my account to another bank.
7. The Bank may approve the full facility applied for or a lesser sum or decline the application in its sole discretion without giving any reasons, such decision of the Bank
may be by endorsement to that effect in the relevant part of the agreement, or by a separate agreement and in either case it shall be effective to bind the parties
without any further act of the borrower.
8. For loan application and credit card application, I confirm that all the above details are correct and that I have read, understood and I agree to be bound by I&M Bank
terms and conditions as amended from time to time and available at https://www.imbankgroup.com/ke/terms-and-conditions/ I also agree to indemnify and hold
I&M Bank Limited harmless from and against all claims arising from any information that I have provided herein.
9. PRIVACY NOTICE: I hereby acknowledge that I have read and understood how the information that I have provided in this form will be used by the Bank as outlined
in the privacy notice available at https://www.imbankgroup.com/ke/information-security/privacy-notice/ and I consent to usage of this data as stipulated therein.
Tick as applicable to confirm acceptance:
Confirm you have read and understood the T&Cs for: Unsecured loan Credit card Signature Date
Confirm you have read and understood the privacy notice Signature Date
For official use only
Customer segment Referred by
Sales person name and contact
Scheme application Yes No
Scheme name
Remarks
Insurance details
Insurance cover rate Premium amount Period
Check list
Copy of ID or Passport
KRA PIN certificate.
Copy of 3 months current payslips
Current six month loan statements (for take over loans)
Current six months bank statements (for new salaried customer)
Confirmation of change of pay point (private companies)
Introduction letter/irrevocable letter from employer
.
Latest CRB report
Branch / sales manager Signature
Bank approver
Decision Supported Declined Refer
Final offer: If different from request (loan amount) Interest rate (% p.a) Tenure (months)
Remarks
Staff name Signature