1.
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Number and amount of loans outstanding at beginning and end of reporting period.
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______
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2.
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Number and amount of loans disbursed during reporting period
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______
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3.
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Number and amount of small saver deposit accounts at beginning and end of reporting period. Show compulsory and voluntary savings separately
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______
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4.
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Arrears (on loans outstanding basis). Unpaid balance of loans with payments overdue more than 30 days. There should also be an aging of arrears report, covering, for example, 60 and 90 days and one year.
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______
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5.
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Percentage of female clients
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______
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6.
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Number of staff (only those involved with savings and credit activities)
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______
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INCOME
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______
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10.
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Interest and fee income from loans (excluding accrued uncollected interest on non-performing loans)
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______
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11.
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Income from investments
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______
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12.
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Other operating income from financial services
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______
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13.
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Total income:
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______
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EXPENSES
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______
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14.
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Staff expenses (salaries and benefits)
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______
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15.
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Other administrative expenses (includes depreciation)
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______
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16.
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Loan losses. All loans over one year in arrears should be written off, as far as local rules permit. Institutions should describe their criteria in recording loan losses.
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______
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17.
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Interest and fee expenses (itemized by source of funds)
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______
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18.
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Total expenses:
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______
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19.
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Net operating profit:
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______
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OTHER INCOME AND EXPENSES
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______
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20.
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Non-operating income (if any)
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______
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21.
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Non-operating expenses (if any)
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______
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22.
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Donations
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______
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22a.
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For operating expenses
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______
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22b.
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Capital contribution (identify purpose, e.g., loan fundequity, fixed assets)
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______
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ASSETS
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______
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23.
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Cash on hand and in banks
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______
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24.
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Mandatory reserves
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______
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25.
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Short-term investments
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______
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26.
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Loans outstanding (must match indicator 1, above)
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______
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27.
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Less: Loan loss provisions
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______
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28.
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Net portfolio outstanding
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______
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29.
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Long-term investments
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______
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30.
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Fixed assets (after depreciation)
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______
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31.
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Other assets
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______
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32.
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Total assets:
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______
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LIABILITIES
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______
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33.
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Savings and time deposits from target group clients
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______
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34.
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Other deposits
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______
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35.
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Loans from central bank
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______
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36.
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Loans from other banks
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______
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37.
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Other short-term liabilities
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______
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38.
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Other long-term liabilities
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______
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EQUITY
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______
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39.
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Paid-in equity (shareholders)
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______
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40.
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Donated equity
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______
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41.
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Retained earnings
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______
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42.
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Other capital accounts
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______
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43.
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Current year profit or loss
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______
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44.
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Total Liabilities and Equity:
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______
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