Company / Organisation Name *

Registration Number *

Business Email *

Phone Number *

Include country code, e.g. +260

Registered Address *

City *

Area of Operation *

Industry / Sector Select… Agriculture Construction Education Finance & Insurance Health Hospitality Manufacturing Mining Retail & Trade Technology Transport Other

Number of Employees Select… 1–10 11–50 51–200 201–500 500+

I consent to the collection and processing of our company's data (including registration documents, financial information and director details) by Chalom Investments Limited for loan application purposes, in accordance with the Zambia Data Protection Act 2021.

I consent to receiving loan status notifications via SMS and email, and to credit information being submitted to a Credit Reference Bureau (CRB) as required for loan processing.

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