Dynamic Form TEST - Make It Happen Loan

Form Test

Testing conditional destination emails based on selected branch

First Name*

Last Name*

Email Address*

Phone Number*

Preferred Branch*

Date of Birth*

Street*

Village

City*

Identification*

ID Number*

TIN*

Marital Status*

Number of Dependants*

Occupation*

Name of Current Employer

Years With Current Employer

Salary*

Loan Amount*

Purpose of Loan Request*

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

YesNo

Bank Loans

YesNo

Others

YesNo

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

Thank you for your submission

A bank representative will contact you within two (2) business days regarding your application.

Thank you for your registering

A confirmation email will be sent.

Need some help completing the form?

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!

Christmas Application Complete!

You did it!

Thank you for completing your application form. We’re one step closer to Lighting Up Your Christmas!

Our loan officer will get in contact with you.