Loan Application Form – Emeraid Capital Management Consults Ltd.

Surname:

Other Names: (optional)

(optional)

Gender:

Male

Female

Date Of Birth:

Marital Status:

Single

Married

Devorce

Other

BVN

Account Number

Bank Name

Home Address:

Office Address:

Telephone Number:

(optional)

Education Qualification:

Career Level:

Place of Work/Business

Position Held:

Years at current place of work/business:

Amount Required:

Purpose:

Net Monthly Income:

Salary Payment Date:

Tenor/ Duration:

30 Days:

60 Days:

90 Days:

Other

Estimated market Value:

Collateral Description:

Passport

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Applicant Signature:

I agree that my typed name below will be as valid as a handwritten signature to the extent allowed by local law

Date: