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Your Full Name *

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Date of Birth *

Nationality *

ID Number (NIK/KTP) *

Marital Status *

Religion *

Mother’s Maiden Name *

Contact Information

Your Mobile *

Email Address *

Current Address *

Postal Code *

Length of Stay at Address *

Employment and Income Details

Occupation/Job Title *

Name of Employer *

Length of Employment *

Monthly Income (IDR) *

Other Income Sources

Loan Details (Minimum Amount 50,000,000 IDR)

Loan Amount (IDR) *

Loan Purpose *

Loan Tenure/Term *

Repayment Method *

Bank Account Details

Bank Name *

Account Number *

Account Name *

Other Details

Emergency Contact

Full Name *

Relationship *

Phone Number *

Address *

Supporting Documents

Upload Photo of e-KTP * Max files: 2 (JPEG, PNG, PDF) 5MB Max

Selfie with e-KTP * (JPEG, PNG, PDF) Max size: 5 MB

Proof of Income * (JPEG, PNG, PDF). Max size: 5 MB

Family Card (JPEG, PNG, PDF) Max size: 5 MB

NPWP (Tax ID) – for loans above 100,000,000 Rupiah

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