VORTA FINANCE

Loan Application Form

Your Goals. Our Support.

Simple / Transparent / Reliable

Personal Loans
Business Loans
Bigger Possibilities

Application Date: Application Reference No. (For Office Use Only):

1Personal Information

Full Name (as on ID): Date of Birth:

Gender: Male Female Other

Phone Number: Email Address: National ID / Passport No.:

Residential Address:

City: State / Province: Country: Postal Code:

2Employment & Income Information

Employment Status: Employed Self-Employed Business Owner Other

Employer / Business Name:

Job Title / Position: Industry: Monthly Income (USD):

Employment Start Date: Work Address (if different from residential):

3Loan Details

Loan Amount Requested (USD):

Purpose of Loan: Personal Business Education Emergency Other

Preferred Repayment Term: 3 months 6 months 12 months 24 months Other

Preferred Funding Method: Bank Transfer Mobile Money Other

4Financial Information

Monthly Expenses (USD):

Other Monthly Obligations (Loans, etc.) (USD):

Bank Name: Account Number:

Savings Current Other

Do you have collateral? Yes No

If yes, type of collateral:

5References

Please provide at least two references (not related to you).

1. Full Name: Relationship: Phone Number: Email Address:

2. Full Name: Relationship: Phone Number: Email Address:

6Additional Information

Is there anything else you would like us to know about your loan request?

7Declaration & Consent

I hereby declare that the information provided in this application is true, complete and accurate to the best of my knowledge. I understand that Vorta Finance may verify my information and credit history, and that providing false information may result in the rejection of my application or legal action. I also consent to the use of my personal information for the purpose of processing this loan application.

Applicant's Signature / Full Name: Date: Full Name (Printed):

By submitting, you confirm that the information supplied is accurate and that you consent to Vorta Finance processing this application for loan assessment.