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Customer Loan Request Form

Date: 2/4/2024 EXISTING


BRANCH: ATU SALES PERSON: Clyde Totep

Customer Details
No. Description Details Remarks
1 Customer Name Alma Kabeuya
2 Employee File# #01537322
3 Customer's D.O.B 12.06.82
- Age below 50 years? #VALUE! #VALUE!
4 Department/School (if EDU) DOE PNG Others
5 Employment Start Date 01.01.2001
6 - No. of Years Employed #VALUE! #VALUE!
7 Customer's Phone# 72181835 Active
8 Photo ID: Attached NID 839833756
9 ID Expiry Date? 18.06.2031 VALID
10 Purpose of Loan? Others (Specify)
Loan Request
No. Description Value Remarks
11 Loan Amount Requested K1,000.00 Outside Policy
12 3rd Party Refinance Value (if any)
13 Net showing on latest Pay Slip K560.00 Attached
14 Proposed Repayment Value K84.00
15 50% NET BM Calculation PASSED? NO Attached
16 CDB report - for Loans above K2,000 YES Attached
- if client has CDB history, how many? 1 Settled/Paid

Sales / Lending Officer use ONLY


No. Description YES/NO Remarks
17 Is customer known/understood well? YES
18 Eligibility PASSED QUALIFIED
19 This loan is; Supported/Not SUPPORTED
20

Comments:

Prepared by:
[Lending Officer Name] 2/4/2024
Name Sign Date

Submitted to:
[Processing Officer Name] 2/4/2024
Name Sign Date
Branches Region
ATU Southern
BNZ Highlands
BUK NGI
DRU Southern
GKA Highlands
HGU Highlands
IBU Highlands
KGA Southern
KIM NGI
KMA Southern
KOP NGI
KVG NGI
LAE MOMASE
MAD MOMASE
MDI Highlands
MNS NGI
MPK MOMASE
PDA Southern
POM Southern
SIM Highlands
TRI Highlands
VNO MOMASE
WBG Highlands
WWK MOMASE

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