Repeat Loan Application form

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 *

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

KRA PIN *

Loan Details

Loan Period (1-3 months) *

Loan Amount *

KES

Loan Purpose

M-Pesa Statement * Choose File No file chosen

Mpesa Password *

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 *

Terms and Conditions * Yes, I agree with the privacy policy and terms and conditions.