Customer Data Update Form – County Finance

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Personal Information

Upload Passport Photogragph here

No file chosen

Prefix

First Name

Middle Name

Last Name

NINEnter you National Identification Number here(NIN)

BVN *Enter you Bank Verification Number here(BVN)

Contact Information

Street Address *

City *

State *

Country

Residential StatusLandlordTenantResidential Status

Select Number of Year(s)(If years is selected, pick number of years)

Date you start living at current address

Day

Month

Year

e.g. 05/12/2019

Phone

Email *

Whatsapp Number

Employment Information Section

Employment StatusFull-timePart-timeRetiredSelf-employedStudentEmployment Status

Street Address *

City

State/Province

Country

Employer's Phone Number

Employer's Work Email Address

Staff I.D NumberStaff Identity Number(optional for Traders and self employed applicants)

Dept/Unit at OfficeDept/Unit at Office or Nature of work if you are self employed

Start Date of Employment

Month

Day

Year

Start Date of Employment or Date you Start your Business

Job Title or Business TypeJob Title or The Type of Business you do

Monthly Income

NGN

The Amount you Earn Monthly

Loan Request Section

Purpose Of Loan

Personal LoanSME/Business LoanAsset FinanceOthers

If Personal/Others. Please Specify the PurposePurpose Of Loan

Loan Amount Requested

NGN

Loan Amount Requested through our county finance mobile app

Affordable Monthly Repayment

NGN

Affordable Monthly Repayment

Loan Tenure in Month(s)Loan Tenure in Month(s)

Do You Have An Existing Loan?YesNoIf Yes, Specify below

InstitutionThe company or institution that you are owing

Date Granted

Month

Day

Year

The Date the loan was Granted

Outstanding Loan Amount (if any)

NGN

Outstanding Loan Amount with other institution if any

Monthly Instalment

NGN

Monthly Instalment with other institution

Account NameOther financial institution account

Bank Account NumberBank Account Number

Means of Identification here

No file chosen

Upload your Means of Identification(e.g. NIN, Driver license, Intl Passport, and etc) .jpg, .png

Signature

No file chosen

Upload your signature by signing on a piece of page and upload here in .jpg, .png

Utility bill uploading

No file chosen

Upload your Utility bill here(e.g. Electricity Bill, Waste collection Bill(Lawma), Water Bill, and etc)

Guarantors information

Guarantor One Full NameEnter your guarantor one full name here

Enter Guarantor One Phone Number

Guarantor One E-mail AddressEnter Guarantor One E-mail Address

Guarantor Two Full NameEnter your guarantor two full name here

Guarantor Two E-mail AddressEnter Guarantor two E-mail Address

Enter Guarantor Two Phone Number

Confirmation and Acceptance

Confirmation & Acceptance

I hereby confirm my application for the above facility and certify that all information provided by me attached thereto is correct and complete. I authorize you to make any inquiry you consider necessary and appropriate for the purpose of evaluating this application.

Yes, I agree with the privacy policy and terms and conditions.

Note: This Loan Request won't be granted or process if customer supply wrong information.