First Name *

Father Name *

Grandfather Name *

Sex *

Age(18+) *

City *

Woreda *

Zone *

Special Name of The Settlement *

House Number *

Residential ID Number *

Phone Number Residential *

Mobile Phone Number

Customer Business License *

Date of The Issuance of Business License

Level of education

Average Monthly Payment

Water *PrivateCommon

Electricity *PrivateCommon

Family monthly income

From Salary *

ETB

From Business *

ETB

Other Income *

ETB

Total Monthly Income in Birr *

ETB

customer's work/employment information

Appraisal and property description

Movable property and Estimation

Cash At Bank *

ETB

Cash At Hand *

ETB

Receivables *

ETB

Stock *

ETB

Total *

ETB

Immovable property and Estimation

Property Type

Value *

ETB

Property Type

Value *

ETB

Property Type

Value *

ETB

Capital

Total Properity *

Capital Amount *

ETB

Total Debt Amount *

ETB

Do you borrowed from other lending institutions before? *NoYes

Do you have a loan from another individual or organization? *NoYes

Info about the loan lequest

Requested Loan Amount *

ETB

Amount of Loan Borrowed Before *

ETB

Loan Cycle *

Purpose of The Loan *

Voluntary saving amount *

ETB

Compulsory saving amount *

ETB

The client has a reliable income/Job *NoYes

Signature

Full Name *

Date *

Agree *I confirm with my signature that the above information is correct.

NB.

Please keep in mind that the form will be submitted to Africa Village Microfinance. This will prioritize your request among other customers and smoothen the entire process. However, to complete your application process, you have to come to our office in person and sign the hard copy form.

Contact Info

Loan Appraisal Form

Appraisal and property description

Info about the loan lequest