Omni New Customer Credit App

Full name *

ID Number *

Email *

Confirm email *

Main phone *

ID Type *

Upload a copy of your ID *

Upload a selfie holding your ID *

Take a picture of your face holding your ID next to it. Make sure that the whole ID and your face are framed in the picture.

Upload a copy of a recent utility bill *

Utility bill should be electricity, water, telephone or cable bill no more than 3 months old.

Upload a copy of 2 recent pay slips *

Pay slip should be no more than 2 months old.

Upload a copy of a job letter

Job letter should state current employment.

ABOUT YOU

Gender *

Date of Birth *

Nationality *

YOUR MARITAL STATUS

Marital Status *

Do you have any dependents? *

This is anybody who depends upon you financially for their support and welfare, e.g. your spouse or children.

Please briefly describe the item(s) you are interested in purchasing below: *

YOUR ADDRESS

Address Line 1 *

Address Line 2

Type of Residence *

Number of years at the address *

Do you currently make rent or mortgage payments? *

EMPLOYMENT DETAILS

Current Occupation *

Employment status *

How long have you been in this employment?

Years *

Months *

Current Work Address Line 1 *

Current Work Address Line 2

Current Employer *

How often do you receive your salary/wages? *

Work Phone Number *

Gross Monthly Income *

The amount you receive before subtracting taxes and any other deductions.

Net Monthly Income *

The amount you receive after subtracting taxes and any other deductions.

Do you currently receive any other income? *

REFERENCE CONTACTS

FIRST REFERENCE

First Name *

A reference is just someone who can verify they know you and provide some information for your application.

Last Name *

Address Line 1 *

Address Line 2

Main Phone Number *

Reference Relationship *

Please provide a brief description of you relationship or working relationship with this person.

SECOND REFERENCE

First Name *

A reference is just someone who can verify they know you and provide some information for your application.

Last Name *

Address Line 1 *

Address Line 2

Main Phone Number *

Reference Relationship *

Please provide a brief description of your relationship or working relationship with this person.