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Loan Amount

Preferred Repayment Period (Tenure in months)

Full Name (As in NRIC)

NRIC/FIN

Sex

Date of Birth

Residency Status

Nationality/Citizenship

Country/Place of Birth

Address

Housing Status

Email Address

Mobile Number

Employment Status

Monthly Income in $

Duration with current company (months)

Total Outstanding Loan Amount With Banks

Total Outstanding Loan Amount With Moneylenders