Micro-credit/Loan Application

Micro-credit/Loan Application
Application Date

MonthDayYear
Date
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Applicant Details
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Residence

OwnedRentedLiving with FamilyOther
Civil Status

SingleMarriedDivorcedWidowed
If married, please enter the name of the spouse

First NameLast Name
Spouse phone number
Number of Children/Dependents
Business/Occupation Details
Name of Business/Occupation
How many years have you been working or trading?
Job/Business start Date

MonthDayYear
Date
Business/Company Name
Job/Business Address*

Street Address

Street Address Line 2

CityState / Province
Type of ID you would like to present?
Please upload any required ID documents here

Cancelof
Loan Details
Requested loan amount?
Loan Terms

3 Months6 Months1 YearOther
Purpose of Loan
Reason why you are requesting for a loan
References

List of References

	Name	Relationship	Company Name	Phone Number
1
2
3

Terms and Conditions
I also confirm that all information in this form is accurate and true.

l authorize ABC Bank to do a background check on me if needed.

I understand that the information I entered in this form will be considered strictly confidential and private.

I understand that the loan I'll receive (if approved) will not be used on any illegal activities.

I agree to indemnify ABC Bank and all of its employees for any liabilities or harm.
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