PERSONAL LOAN APPLICATION FORM

This form should be completed in CAPITAL LETTERS using BLACK INK.

Characters and marks should be similar in style to the following ABC
Access Bank Zambia Limited
1. PERSONAL INFORMATION

Title....................... Surname............................................................ First Names.............................................................

ID Type.......................... ID Number.............................................. Date of Birth & Age ................................../................
Present Residential Address.................................................................................... Phone Number ...............................
2. LOAN DETAILS

Type of Loan HOME LOAN GRZ SCHEME LOAN UNSECURED PERSONAL LOAN HOME ASSET & DEVICE LOAN
(Tick as appropriate)

MHSS LOAN MPOWER LOAN SALARY ADVANCE Others (Please Specify)

Loan Amount........................................... Loan Tenure............................................. Loan Purpose ..........................................

3. WORK DETAILS
Employers Name............................................... Date of Employment................................. Position Held....................................
Nature of Employment (Permanent/Fixed)........................................ Gross Monthly Salary........................................
Net Monthly Salary.............................................................. Monthly Salary Pay Date..............................................of each Month
4. AUTHORITY TO EMPLOYER
I hereby authorize my employer to pay my terminal benefits or final salary directly to Access Bank Ltd in the event of termination
of my employment. I agree and understand that this undertaking shall remain in force throughout the tenure of my facility.

5. DECLARATION AND ACCEPTANCE

1. I......................................................................... hereby apply for the above stated loan amount in the mentioned
period and acknowledge the funds shall be paid out into my Account Number ........................................................held with
Access Bank Ltd. In addition to this I agree to pay all fees; upfront fees, CRB fee and interest that will be charged on the facility
2. I confirm that I am aware that the Bank is obliged to request information from Credit Bureau regarding my financial dealings
and that any adverse information will disqualify me from obtaining any credit facilities from Access Bank Zambia. I further confirm
that I am aware that the Bank is obliged to list any adverse credit information including unpaid cheques and debit orders with the
bureau should I be in default with any of the terms of facilities granted to me and that such information shall be retained by the
Credit Reference Bureau for a period of Seven(7) years from date of repayment.
I confirm that information contained in this application for finance is correct. I informed Access Bank Zambia of all my financial
obligations and commitments.
......................................................................... ................................................ ........................................
Applicant Name Signature Date

6. EMPLOYER`S CONSENT

We confirm correctness of information under paragraph 1, 2 & 3 above undertake that based on the above instructions, we will
pay the salary directly to Access Bank Ltd. This extends to emoluments such as terminal benefits, allowance gratuities, etc.
should the contract of employment be terminated for any reason. We further confirm that we will not accept any change to these
instructions without prior written confirmation of Access Bank Ltd.
Company Name........................................................... Full Name.................................................................................
Title.............................................................................. Signature........................................ Date ...............................
Company Stamp
*Documentation required to accompany application
Latest 3 months stamped pay slip
Identification document (NRC/Passport/Driver`s Licence)
Minimum 3 months bank statement
Letter from employer
Copy of contract
Two Passport size photos
Letter of application for the loan stating amount,
purpose and period
For official use only

Recommended by......................................................... Signature............................ Date........................................

CRM Concurrence........................................................ Signature ............................ Date .......................................

Approved by................................................................. Signature ............................ Date .......................................

PERSONAL LOAN APPLICATION FORM CONFIDENTIAL PAGE 1 OF 1
VERSION 1 JANUARY 2021