Orizontas Capital Loan Application Form

Orizontas Capital Loan Application Form
Applicant Personal Details
Name

First NameLast Name
Phone Number
Email
example@example.com
National ID Number
Physical Home Address

Street Address

Street Address Line 2

CityPostal Address

Postal / Zip Code
Occupation
Place of Work or name of business (if any)
Job Title (if any)
Work or business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work/Business Telephone number
Monthly Net Income
in KSh
Kindly enter the expected dates of salary/wage payment from current date to final suitable date of loan settlement (i.e Jan/03/2022, Feb/03/2022, etc)*
Loan Details
Purpose of Personal Loan

Kindly indicate in space belowOther
Requested Personal Loan Amount
in KSh
Loan repayment term (Maximum 3 months)

1 week2 weeks1 month2 months3 monthsOther
Select a term of repayment

Monthly/weekly installment payment
IMPORTANT

Due to reintroduction of bank to mobile wallet charges and 20% excise duty on the same, kindly note that we shall charge a standard one off fee of Ksh.200 on each loan effective 16/01/2023. This amount shall be payable with the first loan installment.
Payment instructions: (Bank Account/Mobile Payment Details)
Provide phone number if using mobile money/account details if using bank or cheque
Kindly Fill in This Section Only if Paying in WEEKLY Installments
Amount to be paid in week 1
Amount to be paid in week 2
Kindly Fill in this Section Only if Paying in MONTHLY Installments
Amount to be paid in Month 1
Amount to be paid in month 2
Amount to be paid in month 3
Mode of Loan Security
Any other security
Desired loan disbursement date

MonthDayYear
Date
Guarantee by directors
Name

First NameLast Name
Relationship with Applicant
Signatures
Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not loan is approved.
Applicant's Signature
Guarantor's Signature (if applicable)
REFEREE DETAILS.

Kindly indicate the details of the person who referred you to Orizontas Capital
Name
Phone number
Relationship to referee
Years of relationship
Preferred Loan Disbursement Channel
Should be Empty:

Orizontas Capital Loan Application Form

Applicant Personal Details

Loan Details

IMPORTANT

Kindly Fill in This Section Only if Paying in WEEKLY Installments

Kindly Fill in this Section Only if Paying in MONTHLY Installments

Guarantee by directors

Signatures

REFEREE DETAILS.