Loan Form - Nicthanmonies

Loan Amount:

Repayment Plan:

Finance Type:

NicthanTraders

NicthanPaddy

NicthanAssetFinance

NicthanBullet

Title

Surname

First Name

Middle Name (optional)

Bank Verification Number (optional)

Date of Birth:

Gender:

Male

Female

Marital Status:

Single

Married

Others

Telephone Number

Email Address:

Office Email: (optional)

Residential Address

Residential Status

Rented

Owned

Stay with family

Living with (Multiple choice)

Perents

Children

Spouse

Relatives

Friends

Living alone

Means of Identification

International Passport

Driver's License

Voter's card

National ID

ID Number

Marital Status & Dependents

Single

Married

Separated

Divorces

Widowed

Number of Children

Number of Dependants

Parents Phone No

Spouse Phone No

Phone No

Friends Phone No

Educational Status

Primary

Secondary

Graduate

Post Graduate

Employment Detail

Full Time

Part Time

Self-Employed

Business Owner

Outsourced

Contract Staff

Company Name

Industry

Employment Month & Year

Monthly Net Salary

Monthly salary income after taxes

Fixed Monthly Expenses

Loan repayment/Living expense. etc

Current Salary Pay Date

Company Address

Please fill at least one of following options

Working Email Address

Please note that this is not a general mail of the company and it should be contacted

Company Phone Number

Colleague's Name

Colleague's Phone No

Loan Details

Loan Type

3 Months

6 Months

9 Months

12 Months

Purpose of Loan

Business

House rent

Hospital/pharmacy

Education

Agric

Auto

Others(please specify)

Account Name:

If your application is successful, which Bank Account would you like to receive the money?

Account Number:

Bank Name:

Branch:

Sort Code:

TERMS AND CONDITIONS (Please tick that you agree with our terms and conditions)

1. Any amount outstanding as unpaid after expiration of the monthly repayment date will be rolled over at the existing interest rate. 2. Any loan repayment cheque drawn on your salary/active account for repayment should be in favour of NICTHAN NIGERIA LIMITED and borrower should ensure availability of value on due date. Any returned cheque or delayed repayment will attract a stipulated fee per day or 1% per day of the amount due whichever is higher will be applied. 3. 10% will be charged on outstanding amount monthly after expiration of the tenor. 4. There is default charges on unpaid daily and weekly repayment.

Agree

I do not agree

DECLARATION (Please note that

I (Add your name in the field above) hereby declare that all the information provided in this application is correct. I agree that any false information discovered renders my application null and void and subject to litigation. I hereby undertake to repay NICTHAN NIGERIA LIMITED the sums granted to me as loan and the applicable interest promptly and in line with the company's loan terms and conditions. I authorize the Company to verify the information provided on this form in respect of my credit history.