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