First Name
please enter your first name
please enter your first name
Last Name
please enter your lastt name
please enter your lastt name
Date of Birth
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Field is required!
Identification
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Please choose one
Phone Number
please enter phone number
please enter phone number
Phone Number (other)
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Email Address
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Address
please enter address
please enter address
Purpose of Loan
  • - select purpose -
  • Home purchase
  • Car
  • Personal
  • Investment
  • Education
  • Wedding
  • Home Renovations/ Repair
  • Travel
  • Debt consolidation
  • Personal Expenses
  • Other
please select one option
please select one option
Name of Automobile Company
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Field is required!
Name of Salesperson
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Field is required!
Contact of Salesperson
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If Other, specify
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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
  • Winneba
please choose branch
please choose branch
Employer
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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
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Field is required!
Comments
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Please help us to improve our product marketing by participating in this quick survey.

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Where did you first hear/read about this loan offer?
  • - select channel-
  • Online Media
  • Radio
  • TV
  • Newspaper
  • SMS
  • Referral
  • Republic Bank Branch
  • Republic Bank Staff
  • Other channel
please select channel
please select channel
Please select the online medium
  • - select -
  • Social Media
  • Newsportal
  • Youtube
  • Google
  • Whatsapp
  • Other
please online channel
please online channel
Please specify
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Please specify the radio station
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Please specify the TV station
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Please specify the newspaper
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Please specify
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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.

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