Loan Form Contact Information Full Name (Family Name and Giving Name) * Gender MaleFemale Date of Birth * Marital Status SingleMarriedWidow/Widower Current Address Province * District Commune Village Phone Number * Email Income Information Occupation/Business EmploymentBusiness Employer/Business Name Monthly Income (USD) * Loan Information Loan Currency Request USDKHR Loan Amount Request * Loan Tenure (Month) Loan Purpose * Preferred Branch to Apply the Loan * Reference Document Attachment i.e: ID Card, Pay Slip or Bank Statement, Confirmation Letter * Permission for the bank to search CBC record * Agree Do you have an account with Phillip Bank? YesNo Account Number
