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ThirdWell Input Financing Scheme

Input Financing Application Form
Application No: FIN-TWIFS-DRAFT  |  Date Prepared: 10 Jun 2026
Part A — Farmer Details
Ama Farmer 4
FARM-DEMO-0004
Ghana Card
GHA-123456789-0
+233240000004
Demo Community
Techiman
Bono East
Part B — Programme & Field Officer
2026 Maize-Soy Input Finance Programme
Yaw Purchasing Agent
Part C — Farm & Crop Details
Maize
Yellow Maize (Open Pollinated Variety)
3.00
7.6041,-1.9325
Apr 2026
Oct 2026
October 2026
November 2026
30 Nov 2026
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 & Harrowing Land Preparation service 250.00 April Demo Tractor Co. 750.00
2 Improved Maize Seed Seed product 120.00 6.00 60.00 April SeedTech Ghana 360.00
3 NPK 15-15-15 Fertilizer product 400.00 6.00 200.00 May AgroInputs Ltd 1,200.00
4 Weeding (2 rounds) Labour service 180.00 June Community Labour Pool 540.00
TOTAL FINANCING AMOUNT (GHS) 2,850.00
Part E — Expected Yield & Repayment
2200.00
6,600.00
900.00 kg
5,700.00
1,900.00
5,700.00 kg
Part F — Guarantor Details
Kweku Mensah
+233244000099
Techiman North
Brother
2,000.00
TWIFS demo guarantor.
Part G — Farm Visit & Decision
No
DRAFT
Signatures & Declaration
Generated 10 Jun 2026 12:59 · FIN-TWIFS-DRAFT · AgriValue Input Financing System