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Loan Amount (K)

Type of Loan

Loan Tenure

Gender

MaleFemale

First Name

Last Name

NRC Number

Date of Birth

Mobile Number

Marital Status

Number of Children/Dependants

Province

City/Town

Residential Address (Include Street)

Residential Status

How Long at current Address

Employment Status

Name of Employer

Position

Contact Person

Conct Person Phone Number

Business Sector

Employer Contact Number

Length of Employment

Monthly Income(K)

Next of Kin (Full Names)

Nature of Relationship

Next of Kin Residential Address

Next of Kin Mobile Number

I declare that the information given in this application form is correct.