An easy to use WordPress plugin

Loan Application Form

A versatile multistep form to collect loan information. Includes personal details, address, financial data and proof of identity uploads.

Loan amount: ZAR2000
Term: 12 months
Loan amount
Number of months
Interest rate
Total amount repayable
Monthly repayment
Initiation fee (payable upfront)
Please complete all marked fields
Your full name *
Email address *
Telephone Number *
Home Address *
Please complete all marked fields

Income and Employment

Net Income (after deductions) *
Employment *
Name of Employer
Work telephone number
Job title
Business name *
Please complete all marked fields


Your monthly displosable income is
Monthly accomodation cost *
Monthly utilities bills *
Monthly cost of food and groceries *
Existing monthly loan repayments
Other Expenditure (including entertainment)
Please complete all marked fields

Validation and Declarations

Required documents. If you don't have the documents to hand you can send them later.
Valid ID
Proof of address
Last 3 months bank statements
Please complete all marked fields


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If you want the plugin download it here. If you need help setting things up give me a call on 07921 859805 or fill in the form on the Contact page