PERSONAL INFORMATION

Title (required)
Mrs.MsDr.Other

First Name (required)

Last Name (required)

Other Names (required)

Email Address (required)

Telephone Number (required)

Mobile Number (required)

Marital Status (required)
—Please choose an option—SingleMarriedDivorcedWidowWidower

Mother's Maiden Name (required)

Date of Birth (required)

Place of Birth (required)

Home Town (required)

Region (required)

CURRENT EMPLOYMENT DETAILS

Occupation (required)

Job Title / Position (required)

Email of Employer/Company (required)

Address of Employer(s) (required)

GUARANTOR DETAILS

Full Name of Guarantor(s) (required)

Phone Number(s) (required)

Profession (required)

Monthly Income(s) (required)

Employer’s Telephone Number (required)

LOAN DETAILS

Loan Amount Required GH¢ (required)

Monthly Income(s) (required)

Purpose of Loan (required)

Customer’s Account Number (required)

Customer’s Bank (required)

Customer’s Bank Branch (required)

INFORMATION ON PREVIOUS LOAN

Loan Amount GH¢ (required)

Amount Paid (required)

Amount Outstanding (required)

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