SUPPORT REQUEST FORM

SECTION A: APPLICANT INFORMATION

FULL NAME: *

ADDRESS (WITH NEAREST LANDMARK): *

GENDER *

MALE
FEMALE

EMAIL *

MARITAL STATUS: *

OCCUPATION: *

EMPLOYER/BUSINESS NAME: *

WORK/BUSINESS ADDRESS: *

MONTHLY INCOME: *

DO YOU HAVE ANY OTHER SOUCRE OF INCOME? *

IF YES PROVIDE DETAILS *

(for example: POS service= 150,000/Month Online Sales = 100,000/Month)

SECTION B: LOAN REQUEST DETAILS

PURPOSE OF SUPPORT REQUEST *

SCHOOL FEE SUPPORT
HOUSE RENT SUPPORT

SUPPORT AMOUNT REQUESTED (₦): *

PROPOSED REPAYMENT DURATION IN MONTHS/WEEKS/DAYS: *

PREFERRED MONTHLY/WEEKS/DAYS REPAYMENT AMOUNT: *

DATE SUPPORT IS NEEDED: *

SECTION C: BANK INFORMATION

BANK NAME *

ACCOUNT NAME: *

ACCOUNT NUMBER: *

BANK VERIFICATION NUMBER (BVN): *

Note: Support cannot be processed without BVN.

SECTION D: GURANTOR DETAILS

FULL NAME: *

PHONE NUMBER: *

RELATIONSHIP TO APPLICANT: *

OCCUPATION/ WORKPLACE: *

RESIDENTIAL ADDRESS: *

SECTION E: PLEASE UPLOAD ALL REQUIRED DOCUMENTS LISTED BELOW

1. Valid ID (National ID, Driver’s License, Voter’s Card, or International Passport) 2. Recent Passport Photograph 3. Three (3)-month bank statement or proof of income 4. Utility bill or address confirmation 5. Copy of guarantors’ valid ID 6. Guarantors’ recent passport photo

Drop your file here or click here to upload You can upload up to 6 files.

Upload service charge receipt *

click here to upload service charge receipt You can upload up to 1 files.

Upload rent form fee *

click here to upload rent form fee You can upload up to 1 files.

Signature *

Acknowledgement *

I agree to abide by all terms and conditions outlined herein.

Acknowledgement *

I agree to abide by all terms and conditions outlined herein.

Website

Account Name: BONTETECH
Account Number: 0276226027
Bank: WEMA Bank