Apply for Loan | IMMIA FINANCE LIMITED

Application Details

Document Upload

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@csrf

Applicant

{{ $customer->email }} • {{ $customer->phone }}

Customer No: {{ $customer->customer_number ?? 'N/A' }}

Auto-filled Information

Your personal information has been pre-filled from your profile. Please review and update any information that may have changed.

Applicant Details

Your personal information (pre-filled from your profile)

Title

From your profile

Surname

From your profile

First Name

From your profile

Middle Name

From your profile

Date of Birth

From your profile

NRC Number

From your profile

Mobile Number

From your profile

Office Telephone

From your profile

Bank Branch *

Account Number *

Years in Employment *

Employee Number

Year of Retirement

Physical Address

{{ old('physical_address', $customer->address) }}

From your profile

Postal Address *

Town

From your profile

Province

From your profile

Employment Details

Your current employment information

Job Title *

Employer's Name *

Gross Salary (ZMW) *

Net Salary (ZMW) *

Employment Type *

Contract Expiry Date *

Employer Physical Address *

Employer Postal Address *

Employer Town/Province *

Loan Information

Details about the loan you're applying for

Loan Product *

Loan Amount (ZMW) *

Loan Tenure (Months) *

Interest Rate

Estimated Monthly Payment

Purpose of Loan *

Next of Kin Information

Your emergency contact person

Surname *

First Name *

Telephone *

Town *

Province *

Country *

Physical Address *

Postal Address *

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Document Requirements

Please upload the required documents for your loan application

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