Application Form | Stargate

Please complete fields with *

Middle Name

Last Name

Date of Birth

First Name

NRC/Passport/Drivers License Number

Employer of your spouse

Salary/Income

Loan Amount Requested

Loan Tenor (Months)

Maximum Deduction Wanted

Current Credit Commitments (Please indicate the name of the lender, date obtained, term, balance and whether your commitment has been refinanced)

Mobile Phone Number

Address

Alternative Phone Number

Next of Kin

Next of Kin Mobile Number

Next of Kin NRC

Relationship

Name of Employer

Address

Job Title

Employee/Man Number

Contract Expiry Date

Employer Landline

Employer Mobile

Account Holder Name

Bank Name

Account Number

Branch Name/No.

Account Type

Account Opened Date