EQUILOAN APPLICATION FORM (FOR TSC STAFF)
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Date of application |
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Account NO (loan) |
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Date opened |
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Particulars of applicant |
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Surname: _____________________________________ other names: ______________________________________
Date of Birth: __________________________________ Date employed: ____________________________________
I.D No.: ______________________________________ TSC No.: __________________________________________
Station/School: __________________________________________________________________________________
District: ______________________________________ Province: __________________ Dept/code No: ___________
Deduct code No EDS 861 Account Code EQBL office Address: ____________________________________________
Office Tel No: _________________________________ Home Tel No. ________________________________________
Gross salary: __________________________________ Net salary: ________________________________________
(Please attach copy of ID and last 3 pay slips) Details of loan
Loan Amount plus interest: ______________________ Repayment period: __________________________ (months)
Monthly repayments Kshs: ________________________ Purpose of loan: __________________________________
Authority to employer to recover loan through check- off system.
I————————————————————————————————— whose particulars are indicated above, do
hereby give my employer, the Teachers Service Commission of P.O Private Bag Nairobi irrevocable authority to recover from my salary, monthly repayments of Kshs. ____________________________ p.m over a period of
__________________________ months and remit the same to Equity Bank Limited, Head Office PO Box 75104 00200
Nairobi, Kenya for the credit of loan Account No. _________________________ in the event of my termination from
employment for any reason whatsoever, I do hereby authorize my employer to deduct from my final dues and pay outstanding loan to the same banking institution.
Signature: ____________________________________________ Date: _____________________________________
Witness (Head of Dept/School)
Full name: _____________________________________ Signature: ________________________________________
Designation: ____________________________________ TSC No. __________________ Date: _________________
Official stamp: _____________________________________
TSC District Personnel Officer
I confirm that the above named person is a bonafide employee of TSC and the salary details indicated above are correct.
Full name: _____________________________________ Signature: ________________________________________
Designation: ____________________________________ Date: __________________ Stamp: __________________
NB: THIS FORM IS TO BE COMPLETED IN TRIPLICATE. |
CD 16/03 |
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Equity Bank Limited Head Office: NHIF Building (community), 14th floor, P. O. Box 75104-00200 Nairobi. Tel: 020-2736620/17
Fax: 020-2737276, Email: info@ebsafrica.co.ke, Website: www.ebsafrica.com