PETRA MICRO FINANCE BANK
PERSONAL LOAN APPLICATION FORM
ACCOUNT OFFICER A/C No. Balance
PERSONAL DATA
Surname: Other Names
Home Address No. of years at this address
Type of ID ID Number
Telephone (home and cell):
Date Of Birth: Age: Place Of Birth:
Occupation: Education:
Sex Male Female Marital status single married separated
Name of Spouse: Occupation Of spouse:
Number of Dependents & Names
Home Ownership Owned Rented Mortgaged Shared/Others
BUSINESS ACTIVITY:
Type Of Business(Retail, Wholesale, services, manufacturing):
Business Name: Business Address:
Business Telephone(s): No of Years In The Business
Business Partner(If Any) and ownership %: No of Employees:
Estimated Business Assets: Estimated Monthly Sales
Is your business registered/licensed? Yes No Registration/License No.:
Sole proprietor/partner/Limited Company/Cooperative:
Who looks after your business when you’re sick or away?
Are you involved in any other business activity? Yes No If yes, what type of business?
Are you employed apart from owning a business? Yes No
Status of Employment: Regular contractual Monthly income from Employment
Others
Name Of Employer: Telephone of Employer:
Address Of 0mployer: Name Of Manager:
LOAN INFORMATION
Purpose of Loan: Amount Required:
Tenure Repayment Plan Daily Weekly Monthly
Do you have any outstanding loan in Does your spouse have any outstanding loan in any
Any Bank? Yes No Bank? Yes No
If yes how much is your outstanding loan? If yes how much is his/her outstanding loan?
__________________________ _____________________
Name of Creditor/Supplier: Name of Creditor/Supplier:
Name of at least one creditor/supplier that you have borrowed from in the past(this will help you get a loan):
1.
2.
Any current or savings accounts or deposits? If Yes, Amount?
Yes No Name of bank or institution?
Source of repayment Security offered
AUTHORIZATION
I confirm that the above information is true and correct to the best of my knowledge. I am aware that any
false statement may be an immediate cause for denial of this loan. In connection with this application, I
authorize the MFI to obtain such other information as may be required. This authorized includes obtaining
information from suppliers, commercial banks, rural banks, and other creditors while releasing these
institutions from liability under any and all bank secrecy laws.
Also, I agree to abide by MFI’s policies, rule and regulations.
Please debit my account with the appropriate bank charges.
Signature Of Applicant _________________ Date/Place ___________________________
FOR OFFICE USE ONLY
ELIGIBILITY CRITERIA VERIFICATION
Client >18 Nigerian citizen Valid means of Identification with Permanent In same business as that of the Loan
Year < 60 correct name and spelling Business Location request for at least 6 months
Yes No Yes No Yes No Yes No Yes No
ACCOUNT OFFICER NAME:
SIGNATURE: DATE:
