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Full Name *
Nationality * KenyanOther
If Nationality Other (Please specify)
Marital Status * SingleMarriedDivorced
National ID No. / Passport No *
Pin No. *
Postal Address *
Postal Code *
Town *
PF. No. *
Date of Birth *
Country * KenyaTanzania
Telephone / Mobile No. *
Email Address *
Physical / Residential Address *
Name *
Relationship *
Country *
Job Title *
Date of Employment *
Recruitment Date *
Contract Expiry Date *
Employment Type * PermanentContractOther
If Employment Type Other (Please specify)
Physical Address *
Gross Salary *
Net Salary *
Account Name *
Bank Name *
Branch *
Account Number *
Preferred Mode of Payment * EFTChequeM-pesaOther
If Other Mode of Payment (Please Specify)
Loan Amount *
Purpose for Loan *
Repayment Period (months) *
Organisation *
Telephone (office) *
Mobile No. *
Bank / Financial Institution
Original Amount
Present Balance
Monthly Installment
Are you currently active at work? * YesNo
Do you suffer or have ever suffered any ailment, disease, disorder or disability that would affect the decision of African Capital Ltd to process this loan application? * YesNo
If yes, give details
I warrant that the information disclosed by me in this application form is correct in every respect and I hereby authorize and give my consent to African Capital Limited to make any enquirers necessary from time to time to verify the information in my loan application. I understand that African Capital Limited may decline my loan application or may decide to grant me a loan of a lesser amount. I warrant that I have read, understand and shall apply the terms and conditions governing the loan, and agree to be bound by them.
Applicants Name *
Date *
Passport Size Photograph *
Latest original pay slips *
Copy of National Id *
Copy of ATM Card *
Introduction Letter (For TSC Employee Only)
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Terms and conditions
