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ThirdWell Input Financing Scheme

Input Financing Application Form
Application No: FIN-TWIFS-APR  |  Date Prepared: 10 Jun 2026
Part A — Farmer Details
Ama Farmer 10
FARM-DEMO-0010
Ghana Card
GHA-987654321-1
+233240000010
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 (Composite)
4.00
7.5900,-1.9600
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. 1,000.00
2 Composite Maize Seed Seed product 140.00 8.00 70.00 April SeedTech Ghana 560.00
3 NPK Compound Fertilizer product 400.00 8.00 200.00 May AgroInputs Ltd 1,600.00
4 Armyworm Control Spray Pesticide product 80.00 4.00 80.00 July AgroInputs Ltd 320.00
TOTAL FINANCING AMOUNT (GHS) 3,480.00
APPROVED AMOUNT (GHS) 3,480.00
Part E — Expected Yield & Repayment
2500.00
10,000.00
1,500.00 kg
8,500.00
2,125.00
8,500.00 kg
Part F — Guarantor Details
Kofi Acheampong
+233200000088
Nkoranza
Uncle
3,000.00
Part G — Farm Visit & Decision
Yes
08 May 2026
APPROVED
22 May 2026
Full TWIFS assessment completed. Farm visit confirmed.
Signatures & Declaration
Generated 10 Jun 2026 10:49 · FIN-TWIFS-APR · AgriValue Input Financing System