Get the offline form to fill and submit at our office.DOWNLOAD Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Customer Loan Application FormFirst time request *YesNoIf No, loan account numberPERSONAL INFORMATION DETAILSFull Name *FirstLastDate of Birth *Sex *MaleFemaleMarital Status *SingleMarriedWidowedDivorcedEmail Address *Mobile Telephone *Residential Address *Is residence *OwnedRentedDuration of stay (in years) *3 yearsNIN *International Passport NumberDrivers License NumberNo. of dependents *No. of cars currently owned *Name of Guarantor FirstLastGuarantor Phone Number *Guarantor Residential Address *Guarantor length of Employment/Business *Annual Income of Guarantor Guarantor NIN NumberPROFESSIONAL INFORMATION DETAILSHighest Educational Level *First DegreeHNDDiploma/ NCESchool Cert.Other QualificationsType of Employment *Paid EmploymentSelf EmploymentLength of Service *in yearsAge of Business (if self employed)Name of Current Employer *Address of Current Employer *Office Email *Phone No. *Employment Status *Full EmploymentContractExpiry Date of Contract (if any)Employment Classication *Junior StaffSenior StaffJunior ManagementSenior ManagementExecutive ManagementJob Title *Confirmation Status *Annual Income After Tax *Basic Monthly Income *Loan deductions (if any) currently taken out of salaryAmount and TenureBusiness DetailsBusiness Name *Business Address *Age of business *RC Number *Business Phone Number *Credit Facility RequestLoan Type *Amount Required *Loan Purpose *Account Name *Account Number *Bank Name *Loan Duration (months) *12345678910Request Type *First RequestAdditional ReqestI agree to the Loan agreements of BluePeak Capital *YesNoSubmit Download the loan agreeement to fill and submit at our office.DOWNLOAD
