ID Number :
Initails :
Surname :
Monthly Salary :
Cell Number :
Email Address :
Ammount you wish to borrow :	--Select-- 5000 6000 7000 8000 9000 10000 11000 12000 13000 14000 15000 16000 17000 18000 19000 20000 21000 22000 23000 24000 25000 26000 27000 28000 29000 30000