APPLICATION FORM

First Name

First Name is required

Middle Name (Optional)

Last Name

Last Name is required

Valid Email is required

Phone Number

Phone Number must be in the format +2567XXXXXXXX or 07XXXXXXXX

Address

Address is required

NIN (ID Number)

NIN (ID Number) is required

ID Expiry Date

ID Expiry Date is required

Date of Birth

Date of Birth is required

Gender

Please select a gender

Marital Status

Please select a marital status

Loan Amount (UGX)

Loan Amount is required

Loan Purpose

Please select a loan purpose