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Personal Details

Select Title

First Name

Surname

National ID

Mobile Number

Date of Birth

Select Gender

Next Of Kin + Phone Number

Number of Dependants

Bank Name

Bank Branch

Account Number

Employment Details

Client(Loan) Loan

Employer Name

EC Number/Payroll ID

Net Monthly Salary

Address Details

Current Address

Length of Stay At Current Address

Occupation Type (Current Address)

Previous Address

Length of Stay At Previous Address

Occupation Type (Previous Address)

Loan Request

What item would you like to cede as security for the loan? Car || Guarantor || Physical Property || Employer Guarantee || Other

Amount Required (in figures) ZWL$:

Amount Required (in words) ZWL$:

Loan Purpose

Source of Repayment

PLEASE UPLOAD THE FOLLOWING DOCUMENTS

National ID Copy

Proof of Residence Copy

Pasport Size (Photo)

Payslip (Copy)

Confirmation of Employment (Photo)

Signature Photo (Take picture on plain white paper)

I ID-No do hereby declare that the information given above is true and correct, and that should any misrepresentations be contained in this Loan application form, Premier Service Microfinance shall be entitled to immediate full repayment of the Loan plus interest without prejudice to any of its rights. I indemnify Premier Service Microfinance against any liability for any loss or damage suffered by me as a result of inaccurate or incomplete information contained herein.

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