First Name
Last Name
Date of Birth
Identification
Phone Number
Phone Number (other)
Email Address
Address
Purpose of Loan
  • - select purpose -
  • Home purchase
  • Car
  • Personal
  • Investment
  • Education
  • Wedding
  • Home Renovations/ Repair
  • Travel
  • Debt consolidation
  • Personal Expenses
  • Other
Name of Automobile Company
Name of Salesperson
Contact of Salesperson
If Other, specify
Preferred Branch
  • - select your preferred branch-
  • Akontombra
  • Adabokrom
  • Asempaneye
  • Asankragua
  • Adum
  • Asokwa
  • Adabrakra
  • Abossey Okai
  • Agona Swedru
  • Asamankese
  • Adjiringanno
  • Ashaiman
  • Accra Central
  • Accra NewTown
  • Achimota
  • Bolgatanga
  • Baatsonaa
  • Cape Coast
  • Community 25
  • Dansoman
  • Essam
  • Ebankese
  • Kumasi Main
  • Goaso
  • Juaboso
  • KNUST
  • Kumasi Suame
  • Kasoa
  • Koforidua
  • Legon (University)
  • Labone (Private Banking)
  • Madina
  • Ridge
  • Sefwi Wiawso
  • Sefwi Bekwai
  • Techiman
  • Tamale
  • Tema
  • Takoradi
  • Tudu
Employer
Salary Range
  • - select range-
  • GH₵ 500 - GH₵2999
  • GH₵ 3000 - GH₵5000
  • GH₵5000- GH₵7500
  • GH₵7500- GH₵10000
  • GH₵10000- GH₵15000
  • GH₵15000- GH₵20000
  • over GH₵20000
Comments
Best Time to be Contacted
  • - select time -
  • 8am - 9am
  • 9am - 10am
  • 10am - 11am
  • 11am - 12noon
  • 12noon - 1pm
  • 1pm - 2pm
  • 2pm - 3pm
  • 3pm - 4pm

I /WE HEREBY WARRANT AND CONFIRM THAT ALL STATEMENTS MADE HEREIN OR IN ANY ATTACHMENTS HERETO ARE TRUE AND CORRECT AND HAVE BEEN MADE BY ME KNOWING YOU WILL RELY THEREON IN CONSIDERING THIS APPLICATION FOR FACILITIES. I/WE AUTHORISE REPUBLIC BANK GHANA TO OBTAIN FURTHER INFORMATION ON MY/OUR CREDIT HISTORY AND ANY SUCH SOURCE IS HEREBY AUTHORISED TO PROVIDE THE REQUESTED INFORMATION. REPUBLIC BANK GHANA IS ALSO AUTHORISED TO DISCLOSE TO ANY CREDIT BUREAU AND OTHER CREDIT GRANTORS ANY INFORMATION ABOUT MY/OUR CREDIT HISTORY. I/WE AGREE TO JOINTLY AND SEVERALLY INDEMNIFY REPUBLIC BANK GHANA AGAINST ANY AND ALL CLAIMS IN DAMAGES OR OTHERWISE ARISING FROM SUCH DISCLOSURE ON ITS PART.