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Surname First Name Other Names Gender Gender Male Female Date of Birth Marital Status Marital Status Married Single Divorced Widowed Nationality Nationality Afghan Albanian Algerian Andorran Angolan Argentine Armenian Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Belarusian Belgian Belizean Beninese Bhutanese Bolivian Bosnian Motswana Brazilian Bruneian Bulgarian Burkinabè Burundian Cambodian Cameroonian Canadian Cape Verdean Central African Chadian Chilean Chinese Colombian Comorian Congolese Costa Rican Croatian Cuban Cypriot Czech Danish Djiboutian Dominican Ecuadorian Egyptian Salvadoran Equatorial Guinean Eritrean Estonian Swazi Ethiopian Fijian Finnish French Gabonese Gambian Georgian German Ghanaian Greek Grenadian Guatemalan Guinean Guyanese Haitian Honduran Hungarian Icelander Indian Indonesian Iranian Iraqi Irish Israeli Italian Jamaican Japanese Jordanian Kenyan Kuwaiti Laotian Latvian Lebanese Basotho Liberian Libyan Lithuanian Luxembourger Malagasy Malawian Malaysian Maldivian Malian Maltese Mauritanian Mauritian Mexican Moldovan Monégasque Mongolian Moroccan Mozambican Burmese Namibian Nepali Dutch New Zealander Nicaraguan Nigerien Nigerian North Korean Norwegian Omani Pakistani Panamanian Papua New Guinean Paraguayan Peruvian Filipino Polish Portuguese Qatari Romanian Russian Rwandan Saudi Senegalese Serbian Seychellois Sierra Leonean Singaporean Slovak Slovenian Somali South African South Korean Spanish Sri Lankan Sudanese Swedish Swiss Syrian Tanzanian Thai Togolese Trinidadian Tunisian Turkish Ugandan Ukrainian Emirati British American Uruguayan Uzbek Venezuelan Vietnamese Yemeni Zambian Zimbabwean BVN National ID No SECTION 2: CONTACT DETAILS ++ Residential Address State of Residence State of Residence Abia Adamawa Akwa Ibom Anambra Bauchi Bayelsa Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nasarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara Federal Capital Territory (Abuja) Local Government Area (LGA) Local Government Area (LGA) ABIA Aba North Aba South Arochukwu Bende Ikwuano Isiala Ngwa North Isiala Ngwa South Isuikwuato Obi Ngwa Ohafia Osisioma Ugwunagbo Ukwa East Ukwa West Umuahia North Umuahia South Umu Nneochi ADAMAWA Demsa Fufore Ganye Gayuk Gombi Grie Hong Jada Lamurde Madagali Maiha Mayo-Belwa Michika Mubi North Mubi South Numan Shelleng Song Toungo Yola North Yola South AKWA IBOM Abak Eastern Obolo Eket Esit Eket Essien Udim Etim Ekpo Etinan Ibeno Ibesikpo Asutan Ibiono Ibom Ika Ikono Ikot Abasi Ikot Ekpene Ini Itu Mbo Mkpat-Enin Nsit-Atai Nsit-Ibom Nsit-Ubium Obot Akara Okobo Onna Oron Oruk Anam Udung-Uko Ukanafun Uruan Urue-Offong/Oruko Uyo ANAMBRA Aguata Anambra East Anambra West Anaocha Awka North Awka South Ayamelum Dunukofia Ekwusigo Idemili North Idemili South Ihiala Njikoka Nnewi North Nnewi South Ogbaru Onitsha North Onitsha South Orumba North Orumba South Oyi BAUCHI Alkaleri Bauchi Bogoro Damban Darazo Dass Gamawa Ganjuwa Giade Itas/Gadau Jama’are Katagum Kirfi Misau Ningi Shira Tafawa Balewa Toro Warji Zaki BAYELSA Brass Ekeremor Kolokuma/Opokuma Nembe Ogbia Sagbama Southern Ijaw Yenagoa BENUE Ado Agatu Apa Buruku Gboko Guma Gwer East Gwer West Katsina-Ala Konshisha Kwande Logo Makurdi Obi Ogbadibo Ohimini Oju Okpokwu Otukpo Tarka Ukum Ushongo Vandeikya BORNO Abadam Askira/Uba Bama Bayo Biu Chibok Damboa Dikwa Gubio Guzamala Gwoza Hawul Jere Kaga Kala/Balge Konduga Kukawa Kwaya Kusar Mafa Magumeri Maiduguri Marte Mobbar Monguno Ngala Nganzai Shani CROSS RIVER Abi Akamkpa Akpabuyo Bakassi Bekwarra Biase Boki Calabar Municipal Calabar South Etung Ikom Obanliku Obubra Obudu Odukpani Ogoja Yakurr Yala DELTA Aniocha North Aniocha South Bomadi Burutu Ethiope East Ethiope West Ika North East Ika South Isoko North Isoko South Ndokwa East Ndokwa West Okpe Oshimili North Oshimili South Patani Sapele Udu Ughelli North Ughelli South Ukwuani Uvwie Warri North Warri South Warri South West EBONYI Abakaliki Afikpo North Afikpo South Ebonyi Ezza North Ezza South Ikwo Ishielu Ivo Izzi Ohaozara Ohaukwu Onicha EDO Akoko-Edo Egor Esan Central Esan North-East Esan South-East Esan West Etsako Central Etsako East Etsako West Igueben Ikpoba Okha Oredo Orhionmwon Ovia North-East Ovia South-West Owan East Owan West Uhunmwonde EKITI Ado Ekiti Efon Ekiti East Ekiti South-West Ekiti West Emure Gbonyin Ido Osi Ijero Ikere Ikole Ilejemeje Irepodun/Ifelodun Ise/Orun Moba Oye ENUGU Aninri Awgu Enugu East Enugu North Enugu South Ezeagu Igbo Etiti Igbo Eze North Igbo Eze South Isi Uzo Nkanu East Nkanu West Nsukka Oji River Udenu Udi Uzo-Uwani GOMBE Akko Balanga Billiri Dukku Funakaye Gombe Kaltungo Kwami Nafada Shongom Yamaltu/Deba IMO Aboh Mbaise Ahiazu Mbaise Ehime Mbano Ezinihitte Ideato North Ideato South Ihitte/Uboma Ikeduru Isiala Mbano Isu Mbaitoli Ngor Okpala Njaba Nkwerre Nwangele Obowo Oguta Ohaji/Egbema Okigwe Orlu Orsu Oru East Oru West Owerri Municipal Owerri North Owerri West JIGAWA Auyo Babura Biriniwa Birnin Kudu Buji Dutse Gagarawa Garki Gumel Guri Gwaram Gwiwa Hadejia Jahun Kafin Hausa Kaugama Kazaure Kiri Kasama Kiyawa Maigatari Malam Madori Miga Ringim Roni Sule Tankarkar Taura Yankwashi KADUNA Birnin Gwari Chikun Giwa Igabi Ikara Jaba Jema’a Kachia Kaduna North Kaduna South Kagarko Kajuru Kaura Kauru Kubau Kudan Lere Makarfi Sabon Gari Sanga Soba Zangon Kataf Zaria KANO Ajingi Albasu Bagwai Bebeji Bichi Bunkure Dala Dambatta Dawakin Kudu Dawakin Tofa Doguwa Fagge Gabasawa Garko Garun Mallam Gaya Gezawa Gwale Gwarzo Kabo Kano Municipal Karaye Kibiya Kiru Kumbotso Kunchi Kura Madobi Makoda Minjibir Nasarawa Rano Rimin Gado Rogo Shanono Sumaila Takai Tarauni Tofa Tsanyawa Tudun Wada Ungogo Warawa Wudil KATSINA Bakori Batagarawa Batsari Baure Bindawa Charanchi Dandume Danja Dan Musa Daura Dutsi Dutsin-Ma Faskari Funtua Ingawa Jibia Kafur Kaita Kankara Kankia Katsina Kurfi Kusada Mai’Adua Malumfashi Mani Mashi Matazu Musawa Rimi Sabuwa Safana Sandamu Zango KOGI Adavi Ajaokuta Ankpa Bassa Dekina Ibaji Idah Igalamela-Odolu Ijumu Kabba/Bunu Kogi Lokoja Mopa-Muro Ofu Ogori/Magongo Okehi Okene Olamaboro Omala Yagba East Yagba West KWARA Asa Baruten Edu Ekiti Ifelodun Ilorin East Ilorin South Ilorin West Irepodun Isin Kaiama Moro Offa Oke Ero Oyun Pategi LAGOS Agege Ajeromi-Ifelodun Alimosho Amuwo-Odofin Apapa Badagry Epe Eti-Osa Ibeju-Lekki Ifako-Ijaiye Ikeja Ikorodu Kosofe Lagos Island Lagos Mainland Mushin Ojo Oshodi-Isolo Shomolu Surulere NASSARAWA Akwanga Awe Doma Karu Keana Keffi Kokona Lafia Nasarawa Nasarawa Egon Obi Toto Wamba NIGER Agaie Agwara Bida Borgu Bosso Chanchaga Edati Gbako Gurara Katcha Kontagora Lapai Lavun Magama Mariga Mashegu Mokwa Muya Paikoro Rafi Rijau Shiroro Suleja Tafa Wushishi OGUN Abeokuta North Abeokuta South Ado-Odo/Ota Egbado North Egbado South Ewekoro Ifo Ijebu East Ijebu North Ijebu North East Ijebu Ode Ikenne Imeko Afon Ipokia Obafemi Owode Odeda Odogbolu Ogun Waterside Remo North Sagamu ONDO Akoko North-East Akoko North-West Akoko South-East Akoko South-West Akure North Akure South Ese Odo Idanre Ifedore Ilaje Ile Oluji/Okeigbo Irele Odigbo Okitipupa Ondo East Ondo West Ose Owo OSUN Atakunmosa East Atakunmosa West Aiyedaade Aiyedire Boluwaduro Boripe Ede North Ede South Egbedore Ejigbo Ife Central Ife East Ife North Ife South Ifedayo Ifelodun Ila Ilesa East Ilesa West Irepodun Irewole Isokan Iwo Obokun Odo Otin Ola Oluwa Olorunda Oriade Orolu Osogbo OYO Afijio Akinyele Atiba Atisbo Egbeda Ibadan North Ibadan North-East Ibadan North-West Ibadan South-East Ibadan South-West Ibarapa Central Ibarapa East Ibarapa North Ido Irepo Iseyin Itesiwaju Iwajowa Kajola Lagelu Ogbomosho North Ogbomosho South Ogo Oluwa Olorunsogo Oluyole Ona Ara Orelope Ori Ire Oyo East Oyo West Saki East Saki West Surulere PLATEAU Barkin Ladi Bassa Bokkos Jos East Jos North Jos South Kanam Kanke Langtang North Langtang South Mangu Mikang Pankshin Qua’an Pan Riyom Shendam Wase RIVERS Abua/Odual Ahoada East Ahoada West Akuku-Toru Andoni Asari-Toru Bonny Degema Eleme Emohua Etche Gokana Ikwerre Khana Obio/Akpor Ogba/Egbema/Ndoni Ogu/Bolo Okrika Omuma Opobo/Nkoro Oyigbo Port Harcourt Tai SOKOTO Binji Bodinga Dange Shuni Gada Goronyo Gudu Gwadabawa Illela Isa Kebbe Kware Rabah Sabon Birni Shagari Silame Sokoto North Sokoto South Tambuwal Tangaza Tureta Wamako Wurno Yabo TARABA Ardo Kola Bali Donga Gashaka Gassol Ibi Jalingo Karim Lamido Kumi Lau Sardauna Takum Ussa Wukari Yorro Zing YOBE Bade Bursari Damaturu Fika Fune Geidam Gujba Gulani Jakusko Karasuwa Machina Nangere Nguru Potiskum Tarmuwa Yunusari Yusufari ZAMFARA Anka Bakura Birnin Magaji/Kiyaw Bukkuyum Bungudu Gummi Gusau Kaura Namoda Maradun Maru Shinkafi Talata Mafara Zurmi Phone Number Email SECTION 3: EMPLOYMENT / BUSINESS INFORMATION ++ Occupation Select Status Employed Self-Employed Trader Artisan Farmer Unemployed Student Other Employer/Business Name Business Address Nature of Business Years in Business/Employment Average Monthly Income (₦) SECTION 4: LOAN DETAILS ++ Loan Type Loan Type Personal Loan Salary Advance Emergency Loan SME / Business Loan Trade & Inventory Financing Cooperative / Group Loan Loan Amount Requested (₦) Preferred Repayment Period Repayment Period 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months 12 Months Purpose of the Loan Submit Application Our Mission Section 2: Identification Details