Loan Form - Leverage Microfinance Limited

Applicant Name: *

Mobile Number *

Email Address

Postal and Residential Address *

Name of Institution (If applicable)

Staff Number (if applicable):

Institution GPS ADDRESS

Application Date *

Type of Loan

Loan Request Amount

Purpose

Start date *

End date *

Preferred disbursement Method

MOMO

Cheque

Cash

REQUIRED DOCUMENTS (PLEASE UPLOAD THE FOLLOWING REQUIREMENTS IF APPLICABLE)

Passport picture

Upload your ID card

Valid ID card

Upload staff ID

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