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Personal Details
Salutation:
Full Name in NRIC/Passport:
Gender:
Nric / FIN No:
Date of Birth:
Nationality: EP/Fin.
Marital Status:
Email:
Contact Numbers: (Home) (Office) (Mobile)


Residential Address
Block No:
Street Name:
Unit No #:
Postal Code:
Type of residence:
Residence of ownership:


Your Employment Details
Employment Status:
Current Employer:
Job Designation:
Length of Service:
Gross Monthy Salary:
Date of Payday:


Loan Information
Loan Amount Requested:
Do you have any other outstanding loans with other Licensed Money Lenders? :

If yes, Please specify the name of the companies




Preferred Mode of Payment :


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