Loan application form

Date Of Application *

Branch *

State *

Surname *

First Name *

Other Name

Age *

Marital Status

Current Address

How Long Have You Been In This Address *

Accommodation Status

Phone Number *

Employment Status

Name Of Employer *

Address

Work Phone Number *

How Many Years Employed *

Can You Be Contacted Here
Yes No

Are You A Lone Parent?
Yes No

Are You Currently On Loans With Other Financial Institutions/Cooperative Societies
Yes No

If Yes, What Is Your Outstanding Obligation With The Institutions *

Salary/Wages Per Month *

Partner's Salary Per Month *

Trade Income Per Month *

Agricultural Input Per Month

Pension Per Month

House Rent Income Per Month

Other Income Per Month

Rent/Mortgage Per Month

Car Fueling Per Month

Feeding Per Month

Electricity Bill Per Month

Mobile Phone Airtime Per Month

Transportation Per Month

Other Expenses Per Month

Purpose Of The Loan

Amount Requested *

Loan Repayment Duration (In Month) *

Loan Repayment Frequency
Weekly Monthly

Loan Repayment Method
Benefit Direct Salary

Bank Account Number (Omiye) *

Bvn No *

Signature Of Applicant *

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Loan Application Form

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