Loan Application Form

Loan Application Form
Contact Information
Title:
Name*

First NameLast Name
Birth Date

DayMonthYear
BVN
example: 000 000 000 00
Marital Status:*

SingleMarriedOther
E-mail*
example@example.com
Phone*
example: 0803 000 000 0
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived in your given address?*

0-1 Year1-2 Years3-4 Years5+ Years
Employment Information
Present Employer*
Occupation*
Years of experience*

0-1 Year1-2 Years3-4 Years5+ Years
Work address
Gross monthly income*
Loan amount
Proposed tenor (in month)
Loan Type

Pru-advanceMarket-MoniPru-credit
Repayment Plan

Principal and interestInterest only
Weekly repayment

Weekly repayment
Account name
Bank name
Account number
Comments:
KINDLY ATTACHED PASSPORT, REGULATORY ID/ WORK ID, UTILITY BILL etc

Cancelof
Signature

Clear
I authorize prospective Credit Grantors/Lending/Leasing Companies to obtain personal and credit information about me from my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. This information, as well as that provided by me in the application, will be referred to in connection with this lease and any other relationships we may establish from time to time. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus or other credit reporting agencies. **

YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission. **

YES
Should be Empty:

Loan Application Form

Contact Information

Employment Information