Nexia Invest Finance — Financing Application

1
Full Name* This field is required.
First Name
Middle Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Phone Number* This field is required.International phone number with country code selection.
Please enter a valid international phone number.
4
This number has WhatsApp ?
5
Country of Residence* This field is required.
Please Select
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
6
City / Region* This field is required.
7
Type of Financing Requested* This field is required.
Please Select
Please Select
Personal Financing
Business Financing
Project Financing
Organization Financing
Other
8
Requested Financing Amount* This field is required.
Enter a positive financing amount.
9
Currency* This field is required.
Please Select
Please Select
AUD
NZD
USD
WST
VUV
EUR
GBP
FCFA
CAD
CHF
JPY
CNY
INR
SGD
HKD
Other
Select the currency for your application.
10
Desired Financing Term* This field is required.
Please Select
Please Select
6 months
12 months
18 months
24 months
36 months
48 months
60 months
84 months
120 months
Other
11
Purpose of Financing* This field is required.
Please Select
Please Select
Personal Loan
New Business Creation
Expansion of an existing business
Equipment Purchase
Real Estate
Project Development
Working Capital
Refinancing
Funding or project for an NGO
Other
12
Project Description* This field is required.
Brief explain how the funds will be used, and your expected objectives.
0/0
13
Business / Organization Name (optional for personal loan)
14
Estimated Project Start Date
Before? What date do you expect to receive the funds?
Month
Day
Year
15
Occupation / Position* This field is required.
What is your current job, your professional field ?
16
Monthly Income* This field is required.
What is your salary or income per month?
17
Monthly Income Currency* This field is required.
Please Select
Please Select
AUD
NZD
USD
WST
VUV
EUR
GBP
FCFA
CAD
CHF
JPY
CNY
INR
SGD
HKD
Other
18
Source of Repayment* This field is required.
Please Select
Please Select
Salary
Business Revenue
Project Returns
Investment Income
Other
19
Confirmation* This field is required.
I confirm that all information provided is true, accurate and complete to the best of my knowledge.
20
Applicant Signature* This field is required.
Should be Empty: