Personal Information of the Borrower

First Name*

Surname*

Other Name

Date of Birth*

NRC No.*

Citizenship*

Employee No.

Gender* [radio* gender use_label_element "Male" "Female"]

Age

Personal Address

Physical Address*

Town*

Province*

Mobile No.*

Email*

Employer's Details

Work Address

Institution*

Province

Office Phone No.

Employer

Occupation

Length of Service (Years)

Length of Service (Months)

Supervisor’s Name

Supervisor Mobile No.

Next of Kin Details

Name*

Relationship*

Contact No.*

Bank Account Details

Account Number*

Type of Account SavingsCurrent

Bank Name*

Branch Name

Branch Code

Loan Details

Loan Type* Payslip-Based LoanCollateral-Based LoanSalary AdvancePersonal/Soft Loan

Loan Amount (ZMW)*

Repayment Period (Months)*

Document Uploads

Upload NRC*

Upload Payslip*

Upload Bank Statement*

Upload Portrait Photo*

Declaration

[acceptance* terms] I confirm that the information provided is true and I agree to the terms and conditions.