Loan Amount*

Monthly Income*

Purpose of Loan* Purpose of LoanAuto Logbook LoanAsset FinanceBiashara LoanImport LoanPSV LoanSalary Advance LoanPersonal Loan

Repayment Period* Repayment Period1 Month3 Months6 Months12 Months18 Months24 Months36 Months

Full Name*

Email Address*

Mobile Number*

National ID Number*

KRA PIN*

Marital Status* Marital StatusSingleMarriedDivorcedWidowed

Date of Birth*

County*

House No/Name*

Street/Road*

Town/City*

Postal Code

Employment Type* Employment TypeEmployedSelf EmployedBusiness OwnerCasual WorkerFarmerOther

Industry*

Employer/Business Name*

Employment Status*

Work Phone Number

Employer Address*

Next of Kin Full Name*

Relationship*

Next of Kin Phone*

Guarantor Phone Number

Preferred Disbursement Method* Select MethodM-PesaBank Transfer

M-Pesa Registered Number

Bank Name

Bank Account Number

Additional Notes

[acceptance* terms] I confirm that the information provided is true and accurate. I consent to the collection, processing and verification of my information for purposes of evaluating this loan application. [/acceptance]