Please click here for the full details of our Privacy Policy which is relevant to the data we collect with this form.
It is a condition of this loan that you shall NOT make cash or transfer payments to any of our staff or their personal account BUT all repayments (principal, interest and bank charges etc) shall ONLY be by any of the following means: 1. Fidelity Bank Account: 411 000 2443; 2. Access Bank Account: 003 504 3469 or 3. By Cash ONLY on the cash counter within the bank to our cashier
Are you a New Customer? *
Moneytronics Account Number *
Account Officer Name
Title *
Name *
Bank Verification Number *
Gender *
Date of Birth *
Email *
Mobile Phone *
Mobile Phone 2
Residential Address *
Means of Identification *
Means of Identification ID Number *
ID Expiring Date
Marital Status & Dependents *
Number of Children *
Number of Dependents *
Educational Status *
Employer's/Business/Company Name *
Employment Status *
Industry *
Employment/Business Start Date *
Bank Account Number
Number of Staff employed
Business Bank Name
Current Net Monthly Income (₦) *
Current Pay Date *
Loan Entitlement
Current Employer / Business Address
Employer/Business Phone No.
Work/Business Email
Loan Amount Requested (₦) *
Loan Amount in Words *
Loan Tenure *
Loan Tenure (Days/Weeks/Months) *
Security for Loan *
Which Loan Type are you applying for? *
Explain purpose for the Loan *
Identification Upload *
Utility Bill
Bank Statement
Passport Picture *
Signature *
Enter Phone numbers of 4 Close Associates *
Guarantor's Name *
Guarantor's Address *
Guarantor's Bank Verification Number (BVN) *
Guarantor's Email *
Guarantor's Mobile Phone *
2nd Guarantor's Name *
2nd Guarantor's Address *
2nd Guarantor's Bank Verification Number (BVN) *
2nd Guarantor's Email *
2nd Guarantor's Mobile Phone *
3rd Guarantor's Name
3rd Guarantor's Address
3rd Guarantor's Bank Verification Number (BVN)
3rd Guarantor's Email
3rd Guarantor's Mobile Phone
Disbursement Details
Account Name *
Account Number *
Bank Name *
Agreement *
Please Sign below *
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