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Loan Application Entry


PERSONAL INFORMATION


Customer:

BVN:

Title:*

First Name:*

Middle Name:

Last Name:*

Membership Type:
Date of Birth:*

Gender:*


Office Addr.

Resident Addr.

Phone No:*

Email:

Spouse:

Next of Kin

Relationship

NOK Address

NOK Phone:

Customer Alt. Phone:

GUARANTORS INFORMATION


Coop No:

Guarant 1 Name

Telehone:

Email:

Home Address:

BVN:

Photo:

Coop No:

Guarant 2 Name

Telephone:

Email:

Home Address:

BVN:

Photo:



LOAN INFORMATION


Group:

Savings:

Loan Sector:

Reason for Loan:

Bank:


Account No:

Loan App. Form

Principal:

Tenor:

Mthly Repayment

Disb. Method:

Verified BVN:

Verified Bank:

Verified Account: