Emergency Loan

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- Emergency Loan

EMERGENCY LOAN APPLICATION FORM

INSTRUCTIONS TO APPLICANT:

Please complete this form in BLOCK LETTERS.
Incomplete applications will not be processed.
Attach the following documents:

Certified Copy of your Identity Document (ID)
Proof of address (not older than 3 months)
Latest 3 months bank statement

Membership Number *

Full Names *

Surname *

Identity Number *

Date of birth *

Marital Status *

SingleMarriedDivorcedWidowedChoose Marita status from the below

Contact Number (Cell) *

Alternative Contact Number *

Email Address *

Residential Address *

Postal Address (if different) *

EMPLOYMENT / INCOME DETAILS

Current Employer / Business Name *

Position / Occupation *

Work Contact Number *

Monthly Gross Income (R) *

Other Sources of Income(if any) *

LOAN REQUEST DETAILS

Type of Loan *

Emergency Loan

Loan Amount Requested (R) *

Reason for Emergency Loan *

Preferred Repayment Period *3 Months6 MonthsOther

FINANCIAL STATUS

Are you currently under Debt Review? *

YesNo

Do you have existing loans with MIDRAND SACCO or any other financial institution? *

YesNo

Have you ever been blacklisted or had a loan application declined? *

YesNo

FINANCIAL STATUS

5. DECLARATION AND CONSENT

I, the undersigned, declare that the information provided in this form is true, correct, and complete. I authorize MIDRAND SACCO to conduct the necessary verification checks, including a credit check, and to contact my employer(if applicable) for income verification ..I understand that the approval of this application is subject to MIDRAND SACCO's lending policy and availability of funds.

Applicant's Signature *

No file chosen

Date *

Witness Signature *

No file chosen

Date *

REQUIRED ATTACHMENTS

Upload Certified ID *

No file chosen

Latest 3 months bank statement *

No file chosen

Proof of Address (not older than 3 months) *

No file chosen

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