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Pay Day Loans
Loan Amount *	R700 R800 R1000 R1300 R1500 R2000
Loan Term *	1 Months 4 Months 6 Months
Initial loan amount up to R700, but monthly top up amounts increase with a good repayment record (up to R15 000)
Personal Details
Title *
Name *
Surname
Id Number
Cell Number
Work Number
Email Address
Alternate Email
Home Address
Banking Details
Bank Name
Account Number
Type	Savings Cheque
Branch Code
Employment Details
Employer Name
Job Title
Date you started
Employee Number
Salary Frequency
Employment Status
Pay date	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Period of Employment
Gross Salary(as per payslip) *
Nett Salary(As per pay slip) *
Total amount of debit orders(as per bank statement) *
Hr officer name
Hr number
Company address
Postal code
Next of kin Details
Next of kin name
Next of Kin Cell Number
Next of kin address
Credit History
Are you under Debt Review ?	Yes No
Are you under Administration?	Yes No