Name of BANK -------------------------------------------------------

1. How would senior management of Bank rate the following possible

objective for Bank (0= minor objective, 1= imp objective)

a) Financial sustainability 0 1

b) Outreach to poor 0 1

c) Positive impact on income of clients 0 1

d) Positive impact on education and social

status of clients 0 1

2. Does Bank provide loan to (0= never, 1=less than 30% of loan, 2= more
than 30%)

a) Urban areas with nationally below-average socio economic development

0 1 2

b) Rural areas with nationally below-average socio-economic development

0 1 2

c) Workers with unsecured status (no assets and uncertainty on daily

employment)
0 1 2

d) Women 0 1 2

e) Illiterate individuals 0 1 2

3. Does Bank accept to provide loan only secured by “social” collateral

(recommended by trusted third party) (0=never, 1= less than 30%, 2=for
more than 30%)

0 1 2

1
 4. How many different type of loan products does Bank provides?(0=only one,
1=2 or 3, 2=more than 3)
0 1 2

Name of these Products-------------------------------------------------

5. Does Bank provide consumption / emergency loan? (0=no, 1=yes)

0 1

6. How many different type of saving products does Bank provide?( 0=no saving
product, 1= 1 or 2, 2= more than 2) 0 1 2

7. Flexibility of repayment (0= only one program fixed by Bank, 1= program

purpose different formula, 2= schedule is decided with clients when receiving
loan) 0 1 2

8. In rural environment, what is the maximum distance client travels to receive a

loan (0= more than 10 km, 1=less than 10 km)

0 1

9. In urban areas, are credit agents going out of there institutes to meet there
clients?
(0=no, 1=yes) 0 1

10. Has Bank ever conducted market survey to improve quality of service to the
client? (0=no, 1=early stage of MFI, 2=regularly (at least once a year))
0 1 2

2
11. Percentage of client drop-out over last 12 months (0=more than 30%, 1=10-
30%, 2=less than 10%) 0 1 2

12. Non financial services related to financial management (business training,

management of family budget etc) (0= no, 1=for some clients, 2=for all clients on
voluntary basis) 0 1 2

13. Non financial services related to social needs: literacy training, health service,
access to social workers etc (0= no, 1=for some clients, 2=for all clients on
voluntary basis)
0 1 2

14. Does loan statement make difference between amount of principle and
amount of interest to be paid in order to give clear information to borrower
(0=no, 1=yes)
0 1

15. Did Bank ever conducted socio-economic studies to assess the situation of
clients? (0=never, 1=planned in near future, 2=once, 3=regularly)
0 1 2 3

16. Does Bank provides some type of insurance that librates the family from
burden of debt in case of death of borrower (0=no, 1=yes)
0 1

17. Does Bank works with local loan officers who can speaks the local language
and know the local culture (0=no, 1=some loan officers, 2=most of loan officers)
0 1 2