CREDITVILLE NIGERIA LIMITED PASSPORT

PHOTOGRAPH

PERSONAL LOAN APPLICATION FORM

1 CLIENTS PERSONAL INFORMATION BVN:

FULL Name of Applicant:

Female Male Date of Birth (DD/MM/YY): Means of ID:

Marital Status: Telephone:

Next of Kin: NoK Telephone:

House Address:

Nearest Landmark/Bus Stop: State:

Rented Owned

Personal Email: Official E-mail:

2 EMPLOYMENT DETAILS

Employers Name:

Branch Office Address: Telephone:

Designation Employment terms: Permanent Contract

Employment Date: Occupation:

3 LOAN PARTICULARS

Amount applied for (N.)

Tenor (Months)

4 DISBURSEMENT ACCOUNT

Bank NUBAN Account Number

5 LOANS IN OTHER BANKS/FINANCIAL INSTITUTION(S)

Lender's Name Loan Amount Date Granted Tenor Outstanding Amount

3
6 COVENANT
1. I declare that the information given herein is true to the best of my knowledge and belief. I further authorise CREDITVILLE LIMITED to verify the information
given herein and make reference from any person(s)/institution(s) named herein.
2. I hereby permit CREDITVILLE LIMITED to conduct Credit Check on my names, and also share our financial details with appropriate regulatory authorities.
3. I hereby declare that we are not less than 18 years of age as at the tie of this application
4. I agree to be bound by all of the terms and conditions of this loan upon acceptance of offer.

Applicant's Signature & Date:

Credit Officer's Name: Signature & Date