1. Name of Employer: *
2. How did you hear about us? * ---AgentOthers
3. Name of Agent:
5. BVN *

1. Type of Loan * ---New LoanTop Up Loan

1. Upload your Clear Picture *
2. Your Full Name *
3. Address of Organization *
4. Select the Employment Code you have * ---OracleIPPISService No
5. Provide Employee Number *
6. Employment Date *
7. Retirement Date *
8. State of Origin * ---AbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEdoEkitiEnuguGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfaraAbuja FCT
9. Local Government of Origin *
10. Hometown *
11. Nationality * ---NigerianOthers
12. Home Address *
13. Landmark/Bus Stop *
14. Building Description *
15. Date of Birth
16. Phone Number *
17. Alternative Phone Number *
18. Email *
19. Marital Status * ---SingleMarriedDivorced
20. Means of Identification * ---National ID CardInternational passportDriver’s LicenseVoter’s CardFederal or State Health Insurance Scheme CardState Residency CardStaff ID Card
21. ID Number or Code *
22. Date of ID Card Issuance *
23. Date of ID Card Expiry *

1. Name *
2. Relationship *
3. Telephone Number *
4. Address *

* Required

1. Requested Amount *
2. Requested Amount in Words *
3. Requested Loan Tenor in Months *
4. Purpose of Loan *
5. Net Pay *
6. Gross Pay *
7. Repayment Mode * ---Direct DebitChequesPayroll Deduction

* Required

2. Upload ID Card *
3. Upload Payslip for the past 3 months *
4. Upload 3 month bank statement *

1. Account Number *
2. Account Name *
3. Bank Name *
4. Upload Signature *
5. Date of Loan Application *

* Required

By signing and submitting this form, you have agreed that if repayment was not deducted at source for any reason, you undertake to pay by transfer or cash deposit to our bank account - Zenith Bank Plc, Account Name: FTI Credit Ltd A/C 3, 1016486550. Otherwise, defaulting interest of 4% is chargeable on outstanding payments.