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MURABAHA APPLICATION FORM

Affix Your

Passport Size

Photo Here

Application Date: ………./……./201…….

Application fee TZSs………………….… Paid (see section 8)

Receipt number ………………

Type of facility …………………………………

Section 1: Applicant’s particulars and contacts

Applicant’s Name: First _ Surname

Nationality

Place of birth

Your telephone numbers 1)

2)

Gender (F/M): Date of Birth Marital Status: married Y/N

Spouses’ name: his/her Mobile No. _

P. O. BOX Residence location _

Description of residence location: _

E-mail Address

Your house is owned or rented: _ Number of Dependents:

Next of Kin’s name:

Relationship: _ Tel no. _

Do you have an outstanding Loan (Y/N) _________

Which bank__________________outstanding amount

(TZ)_______________Maturity date__________________

Who referred you to us (full name):

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JabalNur Islamic Finance Loan Application Form version 1.0 2014

Section 2: Your Business Profile (for business and group Loan)

Name of the company: _

Type of the business:

_

_

Registration Date _ Registration Number: _

Telephone/Mobile:

Experience in Business: years.

Number of workers employed: Ownership

Who are your Customers _

Who are your Suppliers are:

Your monthly turn over (TZSs.)

Section 3: Financing Requirement (Details )

Amount applied TZS

Purpose: (please provide details)

_

_

_

_____________________________________________________________________________________________________________________________

Section 4: Documents Application Requirements: Put “V” against the available items

Item v Item v

Employment ID Collateral

Voter’s Registration Card Business licenses

Passport Size Photo Letter from local government

Bank statement Reference letter from your bank

Financial statements Business visitation done?

Vendor’s Invoice Application fee paid?

Letter from Guarantor Comments about the requirements(if any)

Section 5: Applicant Declaration

I attest that the details provided above are true and correct, and by my signature below I authorize

the obtaining of any references from other places which may seem beneficial to the company.

Applicant Name: _Signature:

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JabalNur Islamic Finance Loan Application Form version 1.0 2014

Section 7: For official use only

7.1 To be completed by JabalNur officer

Type of loan Date Site/Office/Home visited

Factor

Obtainable Score

Total score

Credit Officer’s Comments

Character

30

Capacity

20

Capital

20

Condition

10

Collateral

10

Common sense

10

Total

100

JNF Officer’s Comments:

I recommend for approval/not recommended for approval (delete one)

Name: Signature: _ Date:

7.2 To be completed by MD

Operations Manager’s Comments: _

_____

I approve/not approve (delete one)

Name: Signature: Date:

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JabalNur Islamic Finance Loan Application Form version 1.0 2014

Section 8: Application Am ount and Fee Structure

No

Min. (TZS) Max.

(Max.)

Application Fee in

TZS

1

300,000.00

500,000.00

20,000