hereby consent thet any items found in my / our possession should be taken by ALPHA KAPITAL MICRO-FINANCE BANK LTD or its assignees. Where I / We fail to pay up My / Our loan with them and credit my / our account with any balance(s) if any.
I / We consent in this knowing the full implications and certify that the above statement has been read and interpreted to me / us in ................................................... language by ........................................................., and I / We appear to clearly understand the same and affix His / Her / Their mark to it in my presence
Dated this ...................................................... Day of ................................................ 20....................
Signature: .........................................................................................
Name:.............................................................................
Address: ...........................................................................................
Phone: ............................................................................................
Date:...........................................................................................................
