Motion Yield Limited

NEW LOAN FORM

Please fill appropriately

Bank Verification Number(BVN)

Title

Surname

First name

Middle name

Maiden Name

Gender

Means of Identification

Other means of identification(if not listed above)

Document number

Select your document issue date

Select your document expiry date

MobileNumber1

MobileNumber2

Your office phone number

Email Address

Home Address

Bus stop to home location

Local Government Area

State of residence

Month

Year

Residence Status

Relationship Status

Marital Status

Number of Children

Number of Dependents

Employment Status

Current Employer

Current employer address

Bus stop to Office

Employer phone number

Staff work Email

Employer Email Address

Employer Website

Staff ID Number

Tax Number

Date Employed

Job title and department

Previous Employer

Previous Employment Address

Number of months in previous employement

How many Jobs have you had in the last 5 years?

Current pay date

Current net monthly income

Industry

Please select you service sector

Loan Services

Purpose of Loan

Please specify other loan expenses

Do you have any existing loan?

Existing Loan

Please specify the company you have existing loan with

Numbers of cars currently owned

Do you have a driver?

Personal Driver

Official driver

Is your driver on mobile contract?

Is your driver on pay as you go?

Next of kin fullname

Relationship with Next of kin

Next of Kin home address

Next of kin mobile number

State loan amount requested

Loan tenure months

Affordable monthly repayment

Disbursement Account Name

Disbursement Account Number

Disbursment Bank Name

Disbursement Bank Branch

Disbursement bank sort code

Advert Medium

Please specify the Newspaper Medium

Please specify the magazine medium

I hereby confirm my application for the above facility and certify that all information provided by me above and attached thereto is correct and complete.I authorize you to make any enquiry you consider necessary and appropriate for the purpose of evaluating this application.

Customer signature date