Date of Application
Loan Amount Requested
Purpose of Loan: (e.g., Debt consolidation, home improvement, business expansion)
Requested Term: (e.g., 12 months, 5 years)
First Name
Middle Name
Last Name
Date of Birth
National Identification Number/Tax ID
Marital Status
Dependents: (Number and ages)
Residential Address
City
State/Province
Postal/Zip Code
Time at Current Address
Residential Status
Phone Number
Email Address
Employment Status
Current Employer/Business Name
Job Title/Occupation
Years with Current Employer
Gross Monthly Income (Before Tax)
Net Monthly Income (Take-home)
Other Sources of Income: (Rental, dividends, etc.)
Assets (What you own) | Amount | Liabilities (What you owe) | Amount | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | Real Estate/Property | Existing Mortgages | |||
2 | Vehicle(s) | Vehicle Loans | |||
3 | Savings/Cash | Card Debt | |||
4 | Investments (Stocks/Bonds) | Personal/Student Loans | |||
5 | Other Assets | Other Liabilities | |||
6 | Total Assets | $0.00 | Total Liabilities | $0.00 |
Rent/Mortgage Payment
Utilities (Power, Water, Internet)
Insurance Premiums
Groceries & Transportation
Existing Debt Repayments
Registered Business Name
Registration Number
Industry Type
Annual Gross Revenue
Annual Net Profit
Is the loan secured?
Description of Collateral: (e.g., Vehicle VIN, Property Address, Equipment)
Estimated Value of Collateral
Have you ever declared bankruptcy?
Are there any unsatisfied judgments against you?
I certify that the information provided in this application is true and complete to the best of my knowledge.
I understand that any false statements may result in the rejection of this application or the immediate termination of any resulting loan agreement.
Signature of Applicant
Form Template Insights
Please remove this form template insights section before publishing.
A successful form is structured to move from "easy" questions to "high-stakes" questions. This builds momentum before the applicant reaches the more sensitive financial disclosures.
The core of the form is the balance sheet. In a digital environment, this should be interactive rather than a static table.
To ensure the data is actionable, the template should go beyond just "Total Income."
Since this is an online form, you want to avoid "Form Abandonment" (where people quit halfway through).
A digital template is incomplete without a way to prove the numbers entered.
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation before publishing.
To configure an element, select it on the form.