Loan Request Form
Personal Info
Address
Business Info
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
Region
City
Sub City
Woreda
House No.
E-mail
citizen identification No.
Mobile Number
Additional Number
P.O.Box
Contact Person Name
Relationship
Phone Number
Business Status
Existing
New
Start up
Field of Business
Agriculture
Manufacturing
Diary Business
Trade
Construction
Service
Textile
Sector of Business
Manufacturing
plc
Small & Midum Business
Textile
Start up Capital
Number of Employees
License Number
Year Started Business.
Tin
Sub City
Woreda
House No.
Monthly Income form the business
Monthly Spending
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
