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Micro Business Loan Application Form
Loan Amount ( Do not use comma) *

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Loan Duration

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First Name *

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Middle Name (Optional)

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Family Name *

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Which state do you reside?

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Home Address *

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WhatsApp Number

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Telephone Number Linked to your BVN *

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Alternate Telephone Number (Optional)

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E-mail Address

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Date Birth *

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Gender *

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Marital Status *

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Educational Level *

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Business Name (Optional)

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Is Your Business Registered? *

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Type of Business




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Business Address (Optional)

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Nature of Business

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Contact Person Full Name - 1 *

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Contact Person Telephone Number - 1 *

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Relationship *

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Contact Person Full Name - 2 *

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Contact Person Telephone Number - 2 *

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Relationship *

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BVN Number Don't know my BVN Dail *565*0# *

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Bank Name *

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Are you a member of Youth Empowerment Nigeria?



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How did you hear about us?

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