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How did you find us?
Please select an option
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First Name:
Surname:
Email Address:
ID no:
Gender:
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Physical Address:
Postal code:
Province
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The Eastern Cape
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Gauteng
KwaZulu-Natal
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Cellphone Number:
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Loan Amount:
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R5000
R6000
R7000
R8000
R9000
R10 000
R11 000
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R13 000
R14 000
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R16 000
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R50 000
>R50 000
Term:
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6 months
12 months
18 months
24 months
30 months
Occupation:
Procedure Type:
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Procedure:
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Years at employment:
Work Telephone:
Gross monthly income:
Total monthly expenses:
Disposable monthly income:
Dr. Name:
Procedure Date (if known):
Security Code:
I hereby authorize the financier to perform the relevant credit enquiries with the credit bureau.
Apply for a Loan
First Health Finance Company Reg. No 2006/035331/07 NCRP 3009 Tel: (021) 421 8508 E-mail
info@fhf.co.za
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