Loan Application Section B form

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Loan Application form

Upload Passport Photogragph here *

Prefix

First Name

Middle Name

Last Name

NIN *Enter your National Identity Number

BVN *Enter your Bank Verification Number

Street Address *

Apartment number *Enter house Number or plot Number

City *

State/Province *

L.G.A *L.G.A of Residence

Country *

Residential Status *

TIME AT CURRENT ADDRESS *YearsMonths

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

Select Number of Months(If Months is selected, pick number of Months)

Number of years or months spent in your current address *

Day

Month

Year

Phone Number *

Mobile Number *

Email Address

Employment Status *Full-timePart-timeRetiredSelf-employedStudent

Employer's Street Address *Current Employer's Address or Business Address

Apartment, suite, Building Number, etc *

City *

State/Province *

L.G.A (of Office) *

Country *

Employer's Phone Number *

Employer's Work Email Address

Staff I.D NumberStaff Identity Number

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

Start Date of Employment *

Day

Month

Year

Start Date of Employment or Date you Start your Business

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

Monthly Income *

NGN

The Amount you Earn Monthly

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 *Affordable Monthly Repayment

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

The Date the loan was Granted

Outstanding Loan Amount

NGN

Outstanding Loan Amount with other institution if any

Outstanding Loan Balance

NGN

Outstanding Loan Balance other institution if any

Monthly Instalment

NGN

Monthly Instalment with other institution

Account Name *Other financial institution account

Bank Account Number *

Bank Name *

Means of Identification here *

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

Signature *

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

Utility bill uploading *

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

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.