LOAN APPLICATION FORM

No. LR :
Full Name (ID
Card) : ____________________________________________________________________________________
Employee ID : _________________________ Join Date (dd/mm/yyyy) : ______________
Job Position : _________________________
Department : ________________________________________________________
Division : _________________________

No of
Requested Amount Says Monthly Salary Deduction
Installments

Purpose of Loan
☐ Home Renovation/ Home Improvement ☐ Medical/ Hospital Expenses
☐ Any other reasons, please specify _________________________________________________________________________

Requestor Direct Supervisor

Date: Date: Date: Date:

(_____________) (____________) (__________) (__________)