Loan Application MAFISA - Department of Agriculture...

Loan Application MAFISA

Client Number:

Application Number:

Loan Number:

Province: _____________________District Municipality: _____________________Local Municipality: ________________ Ward:_____________________

Amount Required: R______________Number of repayments: __________Interest 8% per year Simple: R__________Repayment frequency: __________Total Repayable:R______________Repayment per cycle: R__________Term: months Loan Type:_____________________

Section A: Personal Details

Surname:……………………………………………Initials:…………Title……………….Full Names:…………………………………………………………………………………ID Number: Date of birth: Ethnic Group: Asian Black Colored White Marital Status: Single Divorced Widowed Married: In Community Out of Community Customary/common law Have you applied for or are you under administration? Yes No Have you ever been Insolvent? Yes No Applying on behalf of: Individual Legal Entity Association

Section B: Business DetailsType: Sole Trader Close corporation Private Company Trust Co-operative Section 21 Company Partnership Common property Association Voluntary Association Trading Name of Business:………………………………………………………………..

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Registered Name of Business:…………………………………………………………….Registration Number:…………………………………………………………………….Registered for Tax? Yes No Tax Reference Number:…………………………..Registered for VAT? Yes No VAT Reference Number:………………………...If registered company, please attach list of Names of all Directors/ Members /Shareholders or trustees, their positions, ID Numbers, monthly incomes, resolution to borrow and to nominate some to enter into contract on behalf of the entity.

Section C: Contact Details (Individual & Business)

Home Tel: (………)……………………… Cell Number:……………………………..Work Tel: (………)……………………… Fax Number:……………………………...E-mail:…………………………………………Residential/Business Address:……………………………………………………………

……………………………………………………….Postal Code:……………………..Postal Address:…………………………………………………………………………...………………………………………………………Postal Code:……………………... Please attach proof of residential address Section D: OccupationLegal Entity:Do you have any other business interests apart from planned venture? Yes No Is the purpose of this loan for funding an existing or new business?...............................................Do the members earn monthly incomes? Yes No Annual Turnover of existing business: R………………………………….....................Individual:On what basis do you farm? Full time Part Time Do you earn a monthly income? Yes No Occupation:…………………………………...Name of employer:…………………………………………………………………...Address:………………………………………………………………………………

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……………………………………………………….Postal Code:………………….Telephone Number: (………..)…………………….. Years employed at current employer: ………Years at previous employer:……….......Annual Gross salary: R……………………….. Annual Turnover: R…………………..Tax Reference Number:………………………………………..

Section E: Banking InformationBank Account? Yes No Bank Name:……………………………….Name of account…………………………Account Number:………………………...Branch Name:……………………………..Branch Code:……………………………..Type of account:…………………………Please attach copies of 2 (two) months bank statements.

Section F: LandAccess to land? Yes No Type: Lease Permission to Occupy Own Please attach proof of access to Land.

Section G: Technical/ mentor SupportPlease provide a list or letters with Names, Positions and Contact Numbers, of sources providing technical support for the business/venture.

Attach copy of Memorandum of Agreement in case of mentorship and support.

Section H: Income and Expenditure (Individual & Legal Entity)Income Monthly Annual CommentsSale of Goods RSalary RPension RSocial Grants R

RR

Total R

EXPENSES R Monthly Annual CommentsTransport RTelephone RLoan Repayments RMunicipal Services R

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Insurance RRates & Taxes RRent/Bond RMaintenance RFood RSalaries R

RR

Total R

Total Income/Total Expense %

Section I: Assets & LiabilitiesAssetsDescription Value (R)Fixed

Movable

CashSharesProduce deliveredDebtorsCrops on handSurrender Value of PoliciesOther

Total Assets

Liabilities Description CommitmentBondsHire Purchase

Family DebtOverdraftCredit Card DebtInterest Free LoanOther Debt (Specify)

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Co-OperativeCarry-OverMAFISA AssistanceOtherTotal Liabilities

Net Assets = Total Assets minus Total Liabilities R

Section J: Credit ReferencesPlease specify your current debt commitmentsInstitution (& account number)

Outstanding Debt Contact Number

Total

Section K: Additional Information

Full name of Spouse:…………………………………………………………………………………ID Number of Spouse: Occupation:……………………….Work Tel: (.........)…………………..Fax Number: (……)………………Cell:……………………Employer Name:……………………………..Address:……………………………………………

Name of relative (not staying with you):…………………………………………………………Cell Number:………………………………Work Tel: (…….)………………………………………

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Home Tel: (……..)…………………………Employer:……………………………………………

Name of friend (not staying with you):…………………………………………………………Cell Number:………………………………Work Tel: (…….)………………………………………Home Tel: (……..)…………………………Employer:……………………………………………

Section L: Business Plan (Applicant may solicit assistance from Mentor or Extention officer)Nature of Business:

Location of Land:

Type & Suitability of Land:

Climate:

Production Equipment required:

Water Supply required: (Copy of access to water rights)

Farming and Business knowledge:

Strategy and goals:

Expected Proceeds:Source Crop session Date of Yield Expected

Income

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How and to whom will produce be sold?

How will produce be delivered to the buyer?

Market Contract? Yes No If yes Cession on produce should be provided.

Number of employees who will be directly involved in the business and their responsibilities and experience.

Assistance from commercial farmers? Yes No

Please elaborate on safety of land in terms of livestock, and any possible risks involved eg. Diseases, drought, theft of produce, etc

Additional Information:

Section M: Repayment Loan Amount

Repayment Cycle (monthly/quaterly)

Repayment Amounts

Repayment Dates

Repayment Method

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If client earns a monthly income, agreed monthly repayments will be required based onincome vs. expenses. The actual repayment cycles and amounts should also be clearly indicated.

Section N: Items offered as collateral (especially for loans of > R25 000)Item Current Market Value Pledged to another

lender?

Declaration

I/We hereby declare that all information is to the best of my/our knowledge true, Complete and correct. I/We understand that any information supplied, which proves to be false or misleading could lead to the disqualification of my/our application, of any furtherassistance from MAFISA. Information found to be false/misleading after disbursement,may result in the termination of the loan facility with the requirement of full and final settlement of the amount outstanding immediately.

I hereby give permission to __________________ (institution name) to perform a credit enquiry on my personal and business details and share any information on the performance of this loan, with other credit providers and credit bureau.

Applicant 1:Full Name in Block Letters:

Signature Date PlaceApplicant 2:Full Name in Block Letters:

Signature Date Place

Spouse (if married in community):Full Name in Block Letters:

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Legal Guardian (If younger than 21 but older than 18)Full Name in Block Letters:


For Office Use:I, Full Name in Block Letters:Certify that this application is properly completed and has been signed in my presence

Signature (MAFISA representative)

Date Place

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SECTION P: CASH FLOW PROJECTION (at 100% operation efficiency)

Name: 12th month period from/ to

MONTH TOTALINCOME (PRODUCE) : R R R R R R R R R R R R Other (* ) Total * Specify EXPENSES: Total

Net Cash in flow

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For office use only Verification of MAFISA requirements:

A. CLIENT/LEGAL ENTITY MUST BE

CRITERIA YES NOHistorically disadvantaged individual (HDI)/wholly owned by HDI’s (100% shareholding of members interest)South African Citizen21 Years of age (If 18-21 legal guardian to co-sign)Max 10 members where entity is voluntary associationsAll directors/members of entity must be motivated and actively involved in venture Entity to have formal constitution or articles of association, with board committee and management structureResolution attached (in respect of legal entity)

B. CLIENT/LEGAL ENTITY MUST HAVE

CRITERIA YES NOValid IDProof of Access to land (own/communal/lease)Non-farming household income of < R 20 000 per monthAnnual turnover of < R 300 000 (individuals)Annual turnover < R 700 000, above R 300 000 VAT registered (Legal entity)Willingness & ability to pay

C. AFFORDABILITY

CRITERIA YES NOIncome must be greater than expenses (at least120%)Value of personal Assets must be greater than LiabilitiesCash flow projection must be positiveClient must be able to meet installments as per agreementClearly defined repayment frequency and duration/term

D. CREDIT WORTHINESS

CRITERIA YES NOCredit enquiry PositiveSavings historyWilling to open savings account?

E. DISBURSEMENT

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Amount Invoiced

Amount to Bank AccountTotal Amount to be disbursed

F. REQUIRED DOCUMENTATION

Verified ID DocumentMarriage CertificateCredit enquiry (credit bureau) Report2 months Bank Statements (signed by bank branch manager if project)Proof of access to landProof of Water rights (where applicable)Proof of Address/GPS coordinatesMarket Contract if applicableCession of crop where possible (as collateral substitute)Memorandum of Understanding between Mentor and applicant if applicableRegistered business entity proof of registration or founding StatementList of members, ID numbers, income if legal entityProof of income if applicable (salary slips if monthly x 2)Proof of assets & liabilitiesCopy of maintenance order if applicableOther as per DFI policy

E. RECOMMENDATION/MOTIVATION

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Branch Credit Committee:

NAME DESIGNATION SIGNATURE RECOMMEND: YES/NOYES/NOYES/NOYES/NOYES/NO

DFI Branch Manager

YES/NO

Manager: Credit:

NAME DESIGNATION SIGNATURE APPROVE/DECLINEAPPROVE/DECLINEAPPROVE/DECLINE

Reasons for decline:

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Addendum AINCOME DEDUCTION AUTHORISATION

I, the undersigned,

Surname:_____________________________________Name: _________________________________

ID Number:

Hereby authorise my employer/project manager to deduct the monthly and or seasonal installment as agreed upon, from my salary and/or other independent income managed by the employer/project manager, and to pay these installments to the lender, ________________________________________________________________________

(name and address of the lending institution)

Should the relevant installment be adjusted by the institution as a result of a general increase or decrease in the installment, or should I request the institution to increase or decrease the installment for specified reasons, I confirm that the adjusted amount may be deducted from my salary until such time that I cancel this authorisation in writing or substitute such with a new authorisation.

DEED OF CESSION:

1. I, _____________________________________________________hereby irrevocably cede,

(full name & surname of borrower)transfer and make over to the lender for the amount equal to the outstanding amount right, title and interest in and to all amounts owing by

_______________________________________________________________________________(Registered name of employer/project manager)

and/or successor in title with whom I may be employed/managed, to meet the termination of my employment/project commitment for whatsoever reason, as security for the due and punctual payment by me of all amounts which I may be owing to the lender from time to time, from amounts lent and advanced to me.

2. In the event of me not punctually paying any amount due and owing to the lender as aforesaid, the lender is hereby authorised, in rem suam, then or at any time thereafter, without any further authority of consent from me to:

2.1. give notice of this cession to the employer/project manager and to claim from such employer/project manager the full or any outstanding portion of any amounts due to me, to give a valid receipt or discharge for any such payments and to take actions in its own name in any court of competent jurisdiction to collect the monies payable to me.

2.2. apply these proceeds of all payments received from the employer/project manager, after deducting all costs off, and incidental to recovery thereof (including the costs of legal proceedings), towards the reduction of my indebtedness secured hereunder.

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3. This Deed of Cession shall be irrevocable and shall remain in force until cancelled by the lender. In no case shall this Deed of Cession be cancelled whilst there are any monies secured hereunder owing by me to the lender.

4. I hereby authorise the employer/project manager to make payment of any/or all amounts due to myself by the employer/project at the termination of my employment/project commitment for whatsoever reason and ceded hereunder to the lender and/or its successors in title on demand by the lender for the settlement of the outstanding balance on my loan account with the lender.

5. I hereby cede and authorise the employer/project manager to receive on my behalf all amounts which have been commuted to cash from produce/pension/provident fund and/or its successors in title, and to pay such amounts as maybe necessary to settle the outstanding balance of my loan with the lender.

Signed at ____________________________________on this_____day of ________________

×_____________________________________ _____________________________________ Borrowers signature and date Witness’ signature

The provisions of the above Deed of Cession are hereby accepted by the lender

Signed at ____________________________________on this_____day of ________________

×_______________________________________ _______________________________

On behalf of the lender and duly authorised Witness’ signature

Acceptance of Payroll/Project Income Deduction Authorisation for processing_____________________________________________________________

Deduction (monthly)

Term Balance 1st month

Deduction Term Balance 1st month

Deduction Term Balance 2nd month

Deduction Term Balance 3rd month

Deduction Term Balance 4th

month

I, the undersigned, _________________________________________ in my capacity as

________________________________________________ hereby accept the above

authorisation and undertake to execute same.

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I further undertake to:

Support and manage the borrower in the venture taken on and will do all in my power

to ensure responsible repayment of the outstanding debt, and to make available

where applicable, project bank statements for review by the lending institution,

______________________________________________ and to provide reasons for non-

payment.

* Copy of project bank statement signed by branch manager & signatories

attached hereto.

___________________________________ ______________________________

Employer/Project Manager Date

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Loan Application MAFISA - Department of Agriculture...

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