Lend Assure Loan Application | Old Shoreham Microfinance Bank

Customer Information

Prefix

First Name *

Middle Name

Last Name *

Gender *MaleFemale

Marital Status *SingleMarriedDivorced

If Married, Name of Spouse

Phone Number *

Email Address

Mother's Maiden Name

Street Address

State

Country

Nationality

BVN *

Means of ID

State or Origin

LGA of Origin

Date of Birth *

Place of Birth

Home Town

Next of Kin

Prefix

First Name

Middle Name

Last Name

Street Address

Phone Number

Employment

Name of Employer

Street Address

State

Country

Bank Name(Salary Account)

Length of Service

IPPIS NO:

Date of Employment

Rank

Account Number *

Net Monthly Pay

Date of Retirement

Identification

Form of Identification

If others, please specify

Document Number

Loan Details

Tenor

Month Repayment

Loan Amount (Figures)

Loan Amount (In Words)

Account Officer

Required Documents

Upload National ID card

No file chosen

Up to 6 file with a filesize of 8MB per file.

Upload SignatureUpload your signature

No file chosen

Upload PassportUpload your Passport

No file chosen

Upload Work ID Card

Up to 6 file with a filesize of 8MB per file.

Upload Statement of Account

Up to 6 file with a filesize of 8MB per file.