INITIAL NOTICE
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Part A
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1.
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PARTICULARS OF GRANTOR
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A. Type of Grantor
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Individual
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Company
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Unincorporated body/entity
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B. Details of the Grantor
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Grantor 1:
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Name: .............................................................................................................................................................
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Identifier ..........................................................................................................................................................
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(ID number/Passport number/Registration number):
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KRA PIN number: ........................................................................................................................................
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Date of birth/registration: ..........................................................................................................................
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Postal address: ...............................................................................................................................................
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Email address: ...............................................................................................................................................
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Telephone/mobile number: .......................................................................................................................
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Grantor 2:
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Name: ............................................................................................................................................................
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Identifier .......................................................................................................................................................
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KRA PIN number: .......................................................................................................................................
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Date of birth/registration: .........................................................................................................................
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Postal address: ...............................................................................................................................................
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Email address: ...............................................................................................................................................
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Telephone/mobile number: .......................................................................................................................
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Part B
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2.
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Category of Secured Creditor or their representative
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Part I: Consensual
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Part II: Non-consensual
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3.
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PARTICULARS OF A CONSENSUAL SECURED CREDITOR OR THEIR REPRESENTATIVE
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A. Type of the Secured Creditor or their representative
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Individual
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Company
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Unincorporated body/entity
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B.
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Details of the Secured creditor
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Secured Creditor/representative:
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Name: .................................................................................................................................................
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Identifier ...............................................................................................................................................
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( ID number/Passport number/Registration number):
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KRA PIN number: ......................................................................................................................................
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Date of birth/registration: .........................................................................................................................
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Postal address: ...............................................................................................................................................
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Email address: ...............................................................................................................................................
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Telephone/mobile number: .......................................................................................................................
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Secured Creditor 2/ their representative:
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Name: ............................................................................................................................................................
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Identifier
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(ID number/Passport number/Registration number):
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KRA PIN number: .........................................................................................................................................
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Date of birth/Registration: ..........................................................................................................
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Postal address: ...............................................................................................................................
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Email address: ...............................................................................................................................................
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Telephone/mobile number: .........................................................................................................................
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4.
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DETAILS OF THE COLLATERAL
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A. Type of Collateral
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Motor vehicle
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Livestock
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Crops
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Documents of title
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Intellectual property
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Securities
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Negotiable instruments
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Bank accounts
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All present and after acquired property
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Future proceeds
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Household items
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Furniture
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Stock in trade
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Inventory
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Consumer goods
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Others
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B.
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Description of Collateral (including serial number if any):
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........................................................................................................................................................
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.........................................................................................................................................................
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..........................................................................................................................................................
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5.
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Period of effectiveness: ........................................................................... days/months/years)
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6.
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Maximum amount secured: ......................................................................................(currency)
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7.
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Has grantor's authorization been obtained?
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Yes
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No
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8.
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NON-CONSENSUAL CREDITOR
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A. Type of Creditor
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Official receiver
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Landlord/Representative
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Judgment Creditor1
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Government Agency2
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B.
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Type of Creditor
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Individual
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Company
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Unincorporated body/entity
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C. Details of the Creditor:
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Creditor l:
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Name: ...........................................................................................................................................................
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Identifier .......................................................................................................................................................
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( ID number/Passport number/Registration number):
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KRA PIN number:......................................................................................................................................
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Date of birth/registration: ........................................................................................................................
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Postal address: ............................................................................................................................................
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Email address: .............................................................................................................................................
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Telephone/mobile number: .....................................................................................................................
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Creditor 2:
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Name: ............................................................................................................................................................
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Identifier........................................................................................................................................................
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( ID number/Passport number/Registration number):
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KRA PIN number: ........................................................................................................................................
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Date of birth/registration: ...........................................................................................................................
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Postal address: ...............................................................................................................................................
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Email address: ...............................................................................................................................................
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Telephone/mobile number ........................................................................................................................
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9.
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PARTICULARS OF THE COLLATERAL
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A. Type of Collateral
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Motor vehicle
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Livestock
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Crops
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Documents of title
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Intellectual property
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Securities
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Negotiable instruments
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Bank Account/money
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All present and after acquired property
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Future proceeds
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Household items
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Furniture
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Stock in trade
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Inventory
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Consumer goods
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Others
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B.
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Description of Collateral (including serial number if any):
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........................................................................................................................................................
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..........................................................................................................................................................
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10.
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Date of judgment/decree/order (if any):.. ..................................................(DD/MM/yyyy)
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11.
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Type of judgment/decree/order (if any): ..................................................................................
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12.
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Amount specified in judgment/decree/order: ...................................................... (currency)
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Part C
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13.
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Whether the registration relates to a prior security right .......................................................
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14.
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If other, specify ...............................................................................................................................
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