General Information
Name
*
Phone
*
Gender
*
---------
Male
Female
Other
City
*
Present address
*
Permanent address
*
Profession Information
Profession
*
---------
Self Employed
Salaried
Student
Unemployed
Semester
---------
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Degree
Department
Univeristy/College
Are you Dependent or Independent?
---------
Independent
Dependent
Designation
Department
Organization address
Business name
Business address
Who are you dependent on?
---------
Father
Guardian
Income Information
Monthly income
*
Monthly other income
Product Information
In which product you are intrested?
*
---------
Laptop/Computer
Motorcycle/Electric Bike
Scooty/Electric Scooty
Rickshaw/Rickshaw
Camera/Other Equipment
Home Appliances
Business Capital
Other
What is the name of product you are intrested in?
*
What is the price of the product you are intrested in?
*
Please enter the etstimated value of the product you are intrested in. We will deal in the actual market price of the product of current time.
How many months (tenure) you want/need to repay?
*
---------
12 Months
15 Months
18 Months
20 Months
24 Months
Present address
*
Submit
