Business Name

Proprietor's Name

Telephone Number

Email Address

Loan Amount

Tenor (Duration)
1 month2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months12 months

Purpose of the Loan

Repayment Source
Profits from BusinessInterest Income from InvestmentsSalarySale of AssetsTrade ReceivablesProceeds from Contract PaymentOther

Collateral
Automobile (4-Wheel Drive)Automobile (Saloon Car)Land (with Indenture)Land (Registered at Lands Commission)Building (Residential)Building (Commercial)Investments (T-Bills, Bonds, etc.)Other AssetsGuarantor (Salaried Worker)Guarantor (self-employed)I don't have collateral

Disclosures (New Customers only)
Tick all that applies
The business is registeredHas operated for 2 years+Has a bank (current) accountHas good accounting recordsTotal assets exceeds GH¢20KMonthly revenue exceeds GH¢5KHas no loans with other lendersDoes not owe SSNIT or GRAI am not a new customer