Corporate Loan Form TYPE OF LOAN New Loan (type New Loan) Top Up (type Top Up) COMPANY INFORMATION Company Name * CAC Company Address * OWNERSHIP TYPE Individual Sole Proprieship Partnership Private Others Company Phone * Company Email * BUSINESS PREMISE TYPE Rented Owned Shared Industry BUSINESS OWNER(S) DETAILS (1) Name * BVN * MEANS OF IDENTIFICATION Drivers License International ID National ID Voters Card DESIGNATION/POSITION Director * Owner * Partner * Date Of Birth * Email * Mobile Phone * Nationality * BUSINESS OWNER(S) DETAILS (2) Title/Name BVN MEANS OF IDENTIFICATION Drivers License National ID Voters Card ID No DESIGNATION/POSITION Owner Partners Director Date Of Birth Nationality Mobile No Email BUSINESS OWNER(S) DETAILS (3) Title/Name BVN DESIGNATION/POSITION Director Owner Partner Date Of Birth Nationality Mobile No Email LOAN DETAILS Loan Tenor * Loan Amount Requested * Purpose Of Loan * Monthly Installment * Applicant Signature * Loan Amount * Tenor Of Loan * EXISTING LOAN WITH FIRMUS/OTHER BANK Name Of Lender Repayment Amount Account Number Firmus Expected Payment Date Applicant Name Current Outstanding Type Of Loan Repayment Frequency Today's Date * Expected Pay Off Date Disbursement Bank * Account Number * Account Name * Account Type * Bank Branch * Applicant Signature *
