Loan Application Form

Personal Information

First Name *

Last Name *

Date of Birth *

Choose an identification type *

Front of NRC *

Back of NRC *

Passport Size Photo *

Employment & Income Details

Occupation *

Monthly Income *

Income Proof (Last 3 Payslips/Bank Statement) *

Loan Information

Loan Amount *

For how many days? *

Service Fee

Choose a method of receiving funds *

Enter your bank account number *

Contact Information

Residential Address *

Utility bill proof of residential address *

WhatsApp Location

Phone Number *

References

Next of Kin 1 Full Name *

Contact Number *

Relationship *

Next of Kin 2 Full Name *

Contact Number *

Relationship *

Next of Kin 3 Full Name *

Contact Number *

Relationship *

Reference Full Name

Contact Number