ThirdWell Input Financing Scheme
Input Financing Application Form
Application No: FIN-DEMO-0001 | Date Prepared: 10 Jun 2026
Part A — Farmer Details
FARM-DEMO-0001
Demo Community
Part B — Programme & Field Officer
2026 Maize-Soy Input Finance Programme
Yaw Purchasing Agent
Part C — Farm & Crop Details
7.5860,-1.9410
—
Part D — Crop Budget (Inputs to be Financed)
| # |
Item Name / Description |
Type of Input |
Category |
Cost/Acre (GHS) |
No. Acres |
Qty |
Unit Cost (GHS) |
Month |
Supplier / Provider |
Total (GHS) |
| 1 |
Ploughing |
— |
service |
250.00 |
— |
— |
— |
April |
Demo Tractor Service |
500.00 |
| 2 |
NPK Fertilizer |
— |
product |
400.00 |
— |
2.00 |
400.00 |
May |
Demo Input Supplier |
800.00 |
| 3 |
Improved Seed |
— |
product |
175.00 |
— |
— |
— |
April |
Demo Input Supplier |
350.00 |
| TOTAL FINANCING AMOUNT (GHS) |
1,650.00 |
| APPROVED AMOUNT (GHS) |
1,650.00 |
Part E — Expected Yield & Repayment
2000.00
4,000.00
700.00 kg
3,300.00
1,650.00
3,300.00 kg
Part F — Guarantor Details
Ama Guarantor
1,500.00
Linked to farmer financing application.
Ama Guarantor
Part G — Farm Visit & Decision
Farm visited and all documents confirmed.
Signatures & Declaration
Generated 10 Jun 2026 09:19 · FIN-DEMO-0001 · AgriValue Input Financing System