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LOAN APPLICATION FORM
Title
Mr.
Mrs.
Ms.
Dr.
Prof.
Barr.
Surname
First Name
Gender
Female
Male
Prefer Not
E-mail
Date of Birth
Select Bank Account
Salary Account Number
Phone Number(Linked to BVN)
BVN
Home Address
Place Of Work
Date of Employment
State
Abia State
Adamawa State
Akwa Ibom State
Anambra State
Bauchi State
Bayelsa State
Benue State
Borno State
Cross River State
Delta State
Ebonyi State
Edo State
Ekiti State
Enugu State
Gombe State
Imo State
Jigawa State
Kaduna State
Kano State
Katsina State
Kebbi State
Kogi State
Kwara State
Lagos State
Nasarawa State
Niger State
Ogun State
Ondo State
Osun State
Oyo State
Plateau State
Rivers State
Sokoto State
Taraba State
Yobe State
Zamfara State
Abuja Federal Capita Territory (FCT)
IPPIS/Employment No
Last Salary Amount
Loan Amount
Repayment Tenure
1
2
3
4
5
6
7
8
9
10
11
12
Referral code (optional)
Repayment Amount
₦
{{RepaymentCal}}
Naira per repayment
By clicking sign up, I consent to EITL Obtaining information from relevant 3rd parties as may be necessary , on my employment details, salary payment history, loans, and other related data, to make a decision on my loan application, I also consent to the loan amount being deducted from my salary from source, before credit to my acct, and any outstanding loans being recovered automatically from my Bvn Accounts linked to me, in the case of default.
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