Small Business Loan Application Form

LOAN PRODUCT DETAILS:
• Interest Rate: 9% | Term: 1-6 months | Processing: 36 hours or less
• Disbursement: Within 48 hours | For: Small business owners, entrepreneurs, women, youth

1. APPLICANT INFORMATION

Full Name *

Date of Birth *

Email Address *

Phone Number *

Residential Address *

2. IDENTIFICATION

ID Type *

ID Number *

Date of Issue *

Expiration Date *

3. BUSINESS INFORMATION

Business Name *

Business Type *

Business Location *

Years in Business *

Monthly Income (LRD) *

Monthly Expenses (LRD) *

4. LOAN REQUEST DETAILS

Loan Amount Needed (LRD) *

Repayment Term *

Loan Purpose *

Expected Repayment Start Date *

Expected Repayment End Date *

GUARANTOR 1 INFORMATION *

Full Name *

Phone Number *

ID Type *

ID Number *

GUARANTOR 2 INFORMATION *

Full Name *

Phone Number *

ID Type *

ID Number *

Signature for Guarantor 1 *

Date (DD/MM/YYYY) *

Signature for Guarantor 2 *

Date (DD/MM/YYYY) *

COLLATERAL INFORMATION *

Collateral Type/Description *

Estimated Value (LRD) *

Collateral Location *

Ownership Documentation *

5. REQUIRED DOCUMENTS

Document	Required	Notes
Valid ID - Applicant & Guarantors	✓ Yes	Photo copies
Recent Passport-size Photo	✓ Yes	4x6 cm, color
Collateral Documentation	✓ Yes	Title deed, ownership cert
Business Registration/License	Optional	If registered
Financial Records (6 months)	Optional	Income/expense records

6. CONSENT & DECLARATION

I confirm that all information provided is accurate and truthful. I authorize PassMark MicroFinance Hub to verify all information and conduct credit checks. I understand and accept the interest rate (9%) and loan terms. I agree to use the loan funds only for the stated business purpose. I understand the collateral will be held as security for this loan. I have read and understood all terms and conditions of this loan agreement.

Applicant Signature

Date (DD/MM/YYYY)

7. EMPLOYER VERIFICATION

Employer Name:

Employer Signature:

Date (DD/MM/YYYY):

PASSMARK MICROFINANCE HUB