Date

D D M M Y Y Y Y

Consumer Loan Application Form

Request: First time Yes No If No, loan account number

PERSONAL INFORMATION DETAILS

Current name

Date of birth D D M M Y Y Y Y Marital status: Gender:

Married Single widowed Divorced Male Female

Sex: Male Female E-mail address

Current residential address

Mobile telephone Home telephone

Is residence: Owned Rented Length of time at current residence

International passport number Drivers licence

No. of dependants Number of cars currently owned

Name of spouse

Spouse place of employment Spouse length of employment

Spouse employer address

Annual income of spouse

PROFESSIONAL INFORMATION DETAILS

Highest educational level First degree HND School cert. Diploma/NCE Other qualifications

Type of employment: Paid employment Self employment Length of service Age of business (if self employed)
(in years)

Name of current employer

Address of current employer

Office E-mail Phone no

Name of previous employer

Address of previous employer

Employment status: Full employment Contract Expiry date of contract (if any) D D M M Y Y Y Y

Employment classification: Junior staff Senior staff Junior management Senior management Executive management

Job title

Confirmation status

Income details: After tax annual income Basic monthly salary

Loan deductions (if any) currently taken out of salary

Monthly Quarterly Bi-Annually Annually

CREDIT FACILITY REQUEST

Loan type Loan purpose

Amount required

Tenure in months Up to 60 months depending on loan type

Applicable to personal home loan
No-Wahala Loan - 36 months Executive - 48 months NAOC/Mobil - 60 months

Outright purchase Home construction Equity refinance

First time request Additional request

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Asset category
Type of asset Make Model Invoice value Equity Contribution Net amount

Note that equity contribution is a minimum of 20% of assets cost and purchases can only be made from a list of approved vendors

Proposed mode of principal re-payment: Monthly Quarterly Annual Others

BANK ACCOUNT INFORMATION

Account relationship with UBA

UBA business office where salary is domiciled Account owned Account number Length of account relationship

Account relationship with other banks

Name of other bank Type of account Account number Duration at bank Turnover
(current, savings , deposits) (In months) (Total over last 6 months)

Loans outstanding (with other banks)

Type of loan Amount outstanding Collateral Expiry date Frequency

OTHER BORROWINGS

Mode of principal re-payment: Monthly Quarterly Others

Please note that late repayments/bounced cheques will attract penalties

COLLATERALS
Other security arrangements
Domiciliation of terminal benefits and gratuity
Legal mortgage? Yes No

Cash covered Yes No Yes No

I certify that all the information provided by me above is true, correct and complete.
I authorise you to make any enquiry you consider necessary and appropriate for the purpose of evaluating this application.

Applicant signatories Date

Please note that the bank will charge administrative fees
for processing this application

FOR OFFICE USE

Please check that every question has been answered and the form has been signed also.

Received by: Signature

Name of relationship manager

Date

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