Loan Application Form

This Loan Application Form is only available for loan size up to US$ 30,000.

1. Loan Applicant (Individual)
Name	Please input Name.
Gender	Female MalePlease choose Gender.
Date of Birth	Please choose BirthDate. Age must be 18 or over.
No. ID. Card/Family Book/Others
Address	Please input Address.
Marital status	Single Married Widow/WidowerPlease choose Marital status.
Phone	Please input Telephone
Email	Please input a valid Email
Occupation/Business	Employment BusinessPlease choose Occupation/Business Please input Business Description
Place	Please input place
And	Please input all required fields below.
• Name
• Gender	Female Male
• Date of Birth	Age must be 18 or over.
• No. ID. Card/Family Book/Others
• Relationship	Wife Husband Others
	Next
2. Financial Status (Monthly Cash Flow)
Revenue from Business	Please input Revenue from Business.
Cost of Goods Sold	Please input Cost of Goods Sold.
Operation Expense [?]	Please input Operation Expense.
Tax Expense	Please input Tax Expense.
Profit from Business
Other Revenues [?]
Family Expense [?]	Please input Family Expense
Net Income
Revenue from Salary [?]	Please input Revenue from Salary.
Capital & Source of Fund
a. Assets
• Non Current Asset [?]	Please input Non Current AssetZero is not available.
• Current Asset [?]	Please input Current Asset.Zero is not available.
b. Owner's Equity & Liabilities
• Owner's Equity [?]	Please input Owner's Equity.Zero is not available.
• Liabilities [?]
	Next
Note : Total of "Assets" must equal "Owner's Equity & Liabilities".
3. Monthly Repayment Capacity
Total Repayment
	Next
4. Collateral
Market Price of Land	Please input Market Price of Land.
Market Price of House/Building
	Next
5. Loan Requirement
5.1 Request
Loan Size Chosen by Applicant	Please input Loan Size
Maximum Term (Month)	*
Interate Rate/Year (Min)	% *
Loan Fee (Min)	% *
Type of Repayment	Please choose Type of Repayment Show Loan Schedule Hide Loan Schedule

6. Show Information
Loan Purpose	Please choose Loan Purpose.
	Please input other loan purpose.
5.2 Repayment Capacity (Scenario)
Maximum Loan Allowed
Maximum Monthly Repayment Allowed
Note: fields with (*) are indicator purpose only.
	Calculate Reset Next
This Loan Application Form is only available for loan size up to US$ 30,000.
	Please input the blue character. Please input the blue characters.
Branch
	Send Sending, please wait... Print

We hereby declare that all information provided is clear and correct.
We would like to sign and stamp or offix thumbprint as evident.

Date:..........................................
Sign and Stamp or thumbprint of loan applicant

Name:......................................................

Do you want QR Code (KHQR) or POS for your business?

Please fill our form here and we will contact you and prepare these payment facilities for you. You can request ACLEDA Bank's QR code (KHQR) or POS terminal for your business.

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