LOAN APPLICATION FORM

Personal Information - Step 1 of 7

Passport Upload *

Click or drag a file to this area to upload.

Loan Type *

BVN *

Signature *

Marital Status *

• Mr
• Miss
• Mrs

Surname *

First name *

Middle name *

Religion *

Mother's Maiden Name *

Gender *

• Male
• Female

Marital Status *

• Single
• Married
• Widowed
• Divorced
• Others

Level of Education *

• Primary
• Secondary
• Graduate
• Post Graduate

State of Origin *

Local Government *

Home Town *

Means of Identification *

• Driver's Licence
• Int'l Passport
• National ID
• Voters Card
• Others

Identification No *

Date of Birth *

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Mobile Number *

Alternative Number *

Home Address *

Landmark *

Closest Bustop *

LGA *

Previous Address *

State *

Length of Stay in Current Address *

Accomodation Type *

• Owned
• Rented

Spouse Name

Spouse Phone Number

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Employment Status *

• Employed
• Self Employed

Occupation *

Designation *

Department *

Employer's name *

Office Address *

Staff ID No *

Landmark *

LGA *

State *

Office Email *

Time in Current Employment *

Number of Jobs in Last 3 Years *

HR Telephone No. *

Pension No *

Tax ID No *

Net Monthly Income *

Other Source of Income

Other Earnings

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Amount *

Tenor(months) *

Loan Purpose *

Repayment Mode *

• Cheques
• Cash
• Transfer
• Direct Debit

Any Existing Loan? *

• Yes
• No

Repayment(If Yes)

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Account Name

Account Number

Account Type

Bank Name

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Full name

Relationship

Home Address

Phone Number

Email Address

Employer

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I hereby confirm that I am applying for the credit facility and certify that all the information provided by me above and attached hereto, is true, correct and complete. I authorize you to make any enquiries, you may consider necessary and adequate, for the purpose of evaluating this application.

Full name

Signature & Date

Account Officer Name

Signature & Date

Submit