KGCOLE CASH LOANS – LOAN APPLICATION FORM – Private and Confidential
Short-Term (Payday) Loan Application
Email: kgcoleholdings@gmail.com WhatsApp/Calls: 076 176 5573
Loan Amount:
Client’s Personal Details
ID no: Nationality:
Title: Marital Status:
Surname: Gender:
Full names: Language:
Number of Dependents:
Home Physical Address: Work Physical Address:
Address line1:
Address line2:
Suburb: Town:
Province:
Code:
Client’s Contact Details
Home Tel no: E-mail address:
Cellular no: Facebook name:
Next of kin cell number: Alternative number:
Relationship with the next of kin:
Employer’s Details
Employer Name: Work contact number:
Type (Perm/Contract): Work Contact person:
Employee no: Net Salary:
Appointed on: Pay Frequently (Monthly/Weekly):
Occupation: Salary method (Cash/EFT/Bank Transfer):
Pay date:
Affordability Assessment
Gross Salary: Net Salary: Other Income:
Provide the amounts below that you as the applicant must pay per month (monthly expenses)
Insurance: Transport: Food:
Education: Accommodation: Medical aid:
Maintenance: Water & Electricity: Personal Loans:
Other: Other: Other:
Are you under administration/Debt Counselling/Debt Review? Yes No
I the undersigned, hereby confirm that all data contained on this application form were given freely and are true to the best
of my knowledge. I hereby authorise KGCOLE Cash Loans to make any reasonable enquiries to confirm any of the details in
this application, such enquiries may include the Credit Bereau and Employment Information.
I fully understand the content of this application and instruct KGCOLE Cash Loans to undertake the mandate as detailed herein.
Client Signature: Date:
