LOAN APPLICATION

Title *

Fiist Name *

Last Name

Occupation

Date of Birth

Place of Birth

Mothers Maiden Name

Nationality

Marital Status

Others: Specify

Phone

Email *

Level of Education

Next of Kin

Next of Kin Contact

Full Residential Address *

Employment Status

employed, unemployed or self employed

Current Employer

Department

Position

Employment Duration

Employer's Address

Account Number *

Account Name

Bank Name

BVN Number

Account Type

Loan Amount

Proposed Tenure *

Loan Type *

Declaration

I/We Hereby declare that information given are correct and do undertaketo repay/liquidate the loan facility on or before the due date.

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Name