Passport

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CREDITVILLE NIGERIA LIMITED

CORPORATE LOAN APPLICATION FORM

APPLICANT'S PARTICULARS BVN:

Name of Company

RC No. VAT No. TIN:

Type of entity Ltd Co. Partnership Club Group Others
Business premises Address

Tel 1: Tel 2:

Email Website:
PARTICULARS OF PROPRIETORS

Name of director(s)/Partner(s)/Official(s)
Name Designation Telephone Number

(NB: Attach memorandum, Articles of Association, Board of directors resolution, minutes, etc)

LOAN PARTICULARS

Amount Requested: Tenor:

DISBURSEMENT ACCOUNT
Bank NUBAN Account Number

1.
ACCOUNTS IN OTHER BANKS/FINANCIAL INSTITUTION(S) IN THE NAME BUSINESS/APPLICANT

Bank Branch Account Balance (Dr/Cr)

1.
2.
3.
LOANS IN THE OTHER BANKS/FINANCIAL INSTITUTION(S)
Bank Loan Amount Date Tenor Outstanding amount

(Attach bank statements for both Loans and deposit accounts above)

DECLARATION

We declare that the information given herein is true to the best of my/our knowledge and belief. We further authorize CREDITVILLE
NIGERIA LIMITED to verify the information given herein and make reference from any person(s)/institution(s) named herein.

Name of director/partner/official Signature Date

1. ………………………………………………………………………………………………………………………/………/……....

2. ………………………………………………………………………………………………………………………/…….../……….

3. ………………………………………………………………………………………………………………………/……../……….

(NB: Please AFFIX Copany's SEAL)

Credit Officer Name:

Signature