First Name*
Last Name*
Email Address*
Phone Number*
Preferred Branch* Select your preferred BranchAnna ReginaCamp StreetCorrivertonDiamondD’EdwardLethemLindenNew AmsterdamRosehallTriumphVreed-en-HoopWater Street
Date of Birth*
Street*
Village
City*
Identification* Select OneNational IDDriver's LicencePassport
ID Number*
TIN*
Marital Status* Marital StatusSingleMarriedSeparatedWidowedDivorcedCommon Law
Number of Dependants*
Occupation*
Name of Current Employer
Years With Current Employer
Salary*
Loan Amount*
Purpose of Loan Request* Select OneNew CarHome RenovationTravel/VacationPersonal ExpenseNew AppliancesElectronicsOther
Do you have a Republic Bank Account?* YesNo
Do you have any liabilities at any other financial institution?* YesNo
If Yes, please complete the details below:
Outstanding Balances
Monthly Instalments
Credit Card
YesNo
Hire Purchase
Bank Loans
Others
Please upload the following required documents:
Valid identification (ID card or Passport)
A current Job Letter and two recent payslips for salaried workers
Proof of Address - issued within the last 6-8 months
TIN certificate
We’re happy to assist you if you have any questions. WhatsApp us at 592 600 0087 and an Officer will contact you to help Light Up Your Christmas!