Individual Loan Form TYPE OF LOAN New Loan (Yes/No) Top Up (Yes/No) ACCOUNT NO BVN PERSONAL DETAIL First Name Middle Name Surname Marital Status (type YES/NO) * Single Married Divorced Date Of Birth * Mobile Number Other Number Gender (type YES/NO) * Male Female Email Address homeaddress1 homeaddress2 Nearest Landmark Local Govt Area State_2 Time at Current Address Years_2 Months_2 MEANS OF IDENTIFICATION International Passport Drivers License National ID Card Other Specify EMPLOYMENT DETAIL Official Email Self Employed Unemployed Permanent Employment Contract Temporary On Staff ID Job Title Current Employer Office Address 1 Office Address 2 Nearest Bus Stop State Number of Employers Rented Job Title Time at Current Job Years Spent on the job Months Spent on the job NEXT OF KIN/BLOOD RELATIVE Next of Kin/Blood Relative Name Relationship Address Line 1_2 Address Line 2_2 Temp Residence On Family house On Local Govt Area_2 State_3 Owned Mobile Number_2 Provided by employer Email Address_2 Employer Separated On INCOME DETAIL Net Monthly Income Other Income Specify Credit Information Total Monthly Repayments Bank Disbursement Details Account Number Account Name Savings Account On Current Account On Bank Branch Loan Amount Requested Loan Tenor months Monthly Installment Purpose of Loan Applicants Name Date DDMMYY Cheque nos By delivery of an SMS to any mobile telephone number the Borrower has Cheque State all the cheque numbers you issued lga paydate employmentdate applicantname2 nameofbank applicantname3
