How much do you require?
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First Name *
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Middle Name (Optional)
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Surname Name *
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State of Origin?
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Home Address *
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Which state do you reside?
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WhatsApp Number
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Alternate Telephone Number
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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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Explain briefly how you would spend this Money
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Contact Person Full Name *
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Contact Person Telephone Number *
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Relationship *
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Bank Account Number *
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Bank Name *
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How long have you been doing this business
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Do you have any formal or informal knowledge of doing this Business
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How much personal money do you have for or in this business?
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Have you Attended Youth Empowerment Nigeria Skill Acquisition Programme Before?
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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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*
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