ONLINE LOAN APPLICATION FORM


Personal Details

Surname:
Given Names:
Nationality:
Date of Birth:
Section:
Allotment:
District:
Province:
Marital Status:
Spouse Last Name:
Spouse First Name:
Spouse Employer:
Spouse Contact Details:
Close Relative Name:
Relationship:
Relative Phone:
Workplace:

Employment Details

Payroll #:
Organization:
Department:
Postal Address:
Business Phone:
Email Address:
Position:
Date Started:
Pay Master:
Nambawan Super Number:
NID / Passport No:

Bank Details (Salary Account Only)

Bank:
Account Name:
Account Type:
Branch:
Account Number:

Loan Details

Client Type:
Loan Type:
Current Balance (K):
Offset Amount (K):
Loan Amount Requested (K):
Amount Received (K):
Purpose of Loan:
PVA Amount (K):
Number of Fortnights:
Gross Loan (K):
Gross Salary (K):
Net Salary (K):