Loan Request Form
Loan Request
Collateral
Obligation
First Name
Middle Name
Last Name
Date of Birth
Gender
Male
Female
Marital Status
Married
Unmarried
Devorced
Widowed
Employment Condition
Employed
Unemployed
Own Company
Unkown
Private Employee
Education Level
Diploma
Degree
Masters
P.H.D
1-8 Grade
10 Completed
9-12 Grade
Illiterate
Other
Monthly Income
Monthly Spent
Other Additional Income
Do you have any disablities ?
Yes
no
Lefayda Saving Account Number
Loan Type
Individual
Company
Group
Loan Round
Loan Amount
What do you wish to do with the loan you have requested ?
Type of the Collateral
Collateral Name
Collateral Identification Number
Collateral Amout
Collateral Description
How much do you save per month?
Have you lend money to anyone? How much?
Have you take loan from other institutions?
Yes
no
Institution Name
Loan_amount
Loan Taken Date
Loan Closing Date
Remaining Loan Amount
