Loan Application

Complete all sections for KYC, AML, risk scoring, and underwriting review.

1. Personal Information

Identity fields are required for KYC validation.

First Name *

Middle Name

Last Name *

Date of Birth *

Gender *

Marital Status

Nationality *

Government ID Number *

Tax Identification Number

2. Contact Information

Phone Number *

Email Address *

Street *

City *

State / Region *

Postal Code *

Country *

Years At Current Address *

3. Employment & Income

Employment Status *

Employer Name

Job Title

Employment Type

Years Employed

Monthly Gross Income

Monthly Net Income

Other Monthly Income Streams

Rental Income

Investments

Government Benefits

Alimony / Child Support

Income Type

Amount

Description

4. Monthly Expenses & Existing Liabilities

Rent or Mortgage

Utilities

Food

Transportation

Insurance

School Fees

Child Support

Other Recurring Obligations

Existing Liabilities

Liability Type

Lender Name

Outstanding Balance

Monthly Repayment

5. Loan Details

Loan Type *

Requested Amount *

Currency *

Repayment Period (months) *

Repayment Frequency *

Preferred Disbursement Method *

Loan Purpose *

Collateral Offered

6. Banking Information

Bank Name *

Account Name *

Account Number

IBAN

Branch

7. Credit & Compliance Declarations

I consent to credit bureau checks. * I consent to income verification. * I consent to employment verification. * I consent to sanctions screening. * I consent to fraud checks. * I am a politically exposed person (PEP).

Tax Residency Declaration

Source of Funds

Bankruptcy History

Litigation History

Criminal Record Disclosure

8. Documents & Legal Agreements

Allowed formats: PNG, JPG, JPEG, PDF, WEBP.

Government ID *

Selfie / Biometric Verification *

Payslips / Income Proof

Bank Statements (3-6 months) *

Tax Returns

Collateral Document

Legal Agreements

I accept the loan agreement. * I accept interest rate and APR disclosure. * I accept total repayment disclosure. * I accept fees and penalties disclosure. * I accept privacy policy. * I consent to electronic signature. * I confirm all information provided is true and accurate. *

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