Application Form

Please note that we do not charge any fees for our services.

For Personal Loans, Blacklisted Loans, Pay Day loans, Consolidation Loans, Debt Counseling, Sequestration, Debt Mediation complete the form below, make sure all info is correct please.

Other Services: To Apply for a Cell Phone Contract Click Here, To Apply for a Home Loan Click Here, To Apply for Your Free Credit Report Click Here.

Applying For?

Loan Amount

Email Address

ID Number

First Name

Last Name

Marital Status

Employment Status

Which province do you live in?

Work Number

CellPhone Number

Company Name

Start Date

Pay Date

Bank Name

How Old Is Your Account?

Gross Salary

Nett Salary

Monthly Expenses

Only groceries, transport, household....expenses not accounts

I'm interested in a quote for Life Insurance *

Please note that this does not form part of your loan application.

Interested in a complimentary Will and Testament?

Please note that this does not form part of your loan application. You will get a call from Capital Legacy for a quotation.

Are Your Currently Under?

Remember when applying for loans online that there a many companies out there charging fees for applying. Read the term and conditions properly and don’t just give your banking details or other personal info out to any one.

Application Form

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