Apply for Loan | IMMIA FINANCE LIMITED

Form Information

Route: {{ route('customer.loan.application.submit') }}
Method: POST | CSRF: {{ csrf_token() ? '✅ Present' : '❌ Missing' }}

@if($errors->any())

Please fix the following errors:

{{ $error }}

@endif @if(session('success'))

Success!

@endif @if(session('error'))

Error!

@endif

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.

@csrf

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 * @error('bank_branch')

@enderror

Account Number * @error('account_number')

@enderror

Years in Employment * @error('employment_years')

@enderror

Employee Number

Year of Retirement

Physical Address

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

From your profile

Postal Address * @error('postal_address')

@enderror

Town

From your profile

Province

From your profile

Employment Details

Your current employment information

Job Title * @error('job_title')

@enderror

Employer's Name * @error('employer_name')

@enderror

Gross Salary (ZMW) * @error('gross_salary')

@enderror

Net Salary (ZMW) * @error('net_salary')

@enderror

Employment Type * @error('employment_type')

@enderror

Contract Expiry Date * @error('contract_expiry_date')

@enderror

Employer Physical Address * @error('employer_physical_address')

@enderror

Employer Postal Address * @error('employer_postal_address')

@enderror

Employer Town/Province * @error('employer_town_province')

@enderror

Loan Information

Details about the loan you're applying for

Loan Product * @error('loan_product')

@enderror

Loan Amount (ZMW) * @error('loan_amount')

@enderror

Loan Tenure (Months) * @error('loan_tenure')

@enderror

Interest Rate

Estimated Monthly Payment

Purpose of Loan * @error('loan_purpose')

@enderror

Next of Kin Information

Your emergency contact person

Surname * @error('kin_surname')

@enderror

First Name * @error('kin_first_name')

@enderror

Telephone * @error('kin_telephone')

@enderror

Town * @error('kin_town')

@enderror

Province * @error('kin_province')

@enderror

Country *

Physical Address * @error('kin_physical_address')

@enderror

Postal Address * @error('kin_postal_address')

@enderror

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