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New Application form
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Personal Details
Mr./Mrs./Miss/M.S
Surname
*
Other Names
*
Date Of Birth
ID/Passport Number
*
Marital Status
No. Of Dependents
KRA PIN
*
Phone
*
Alternative Contact Number
*
Work Email Address
*
Applicant Address Details
Postal Address
*
Postal Code
*
Town/City
*
Residential Address
Location (e.g South B)
*
Estate (e.g Hazina Estate)
*
Building (e.g Crown Plaza)
*
House Number
*
City/Town
*
Description/Nearest Landmark
*
Applicant Employment Details
Employer's Name
*
Specific Title
*
Terms of Employment
*
Select…
Permanent
Contract
Casual
Staff Number/Payroll Number
*
Employer Location/Station
*
How long have you been working for your current employer?
Monthly Gross Salary
*
KES
Monthly Net Salary
*
KES
Loan Details
Loan Period (1-3 months)
*
Select…
1 Month
2 Months
3 Months
Loan Amount
*
KES
Loan Purpose
Referral Person
1st Referee (Must be Colleague)
Surname
*
Other Names
*
Phone
*
ID/Passport Number
*
Employer's Name
*
Location/Station
*
2nd Referee/Next of Kin (Spouse, Relative or friend)
Surname
*
Other Names
*
Phone
*
ID/Passport Number
*
Employer's Name
*
Location/Station
*
File Uploads
Passport Photo
*
Choose File
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ID Front
*
Choose File
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ID Back
*
Choose File
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Current Payslip 1
*
Choose File
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Current Payslip 2
*
Choose File
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Current Payslip 3
*
Choose File
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3 Months M-pesa Statement
*
Choose File
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3 Months Bank Statement
*
Choose File
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Mpesa Password
Bank Statement Password
Terms and Conditions
*
Yes, I agree with the
privacy policy
and
terms and conditions
.
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