Loan Application Form Lend Assure wants to gain a better understanding of you and your business to give your application a review. Get approved as soon as possible and have money in your account. Bio Data - Step 1 of 7Title *MrMrsMissOthersOthers (Please Specify) *Gender *MaleFemaleName *FirstMiddleLastMarriage Status *MarriedSingleOthersOthers (Please Specify) *Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality *Select your NationalityAfghanAlbanianAlgerianAmericanAndorranAngolanAntiguansArgentineanArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBarbudansBatswanaBelarusianBelgianBelizeanBenineseBhutaneseBolivianBosnianBrazilianBritishBruneianBulgarianBurkinabeBurmeseBurundianCambodianCameroonianCanadianCape VerdeanCentral AfricanChadianChileanChineseColombianComoranCongoleseCongoleseCosta RicanCroatianCubanCypriotCzechDanishDjiboutiDominicanDominicanDutchDutchmanDutchwomanEast TimoreseEcuadoreanEgyptianEmirianEquatorial GuineanEritreanEstonianEthiopianFijianFilipinoFinnishFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuinea-BissauanGuineanGuyaneseHaitianHerzegovinianHonduranHungarianI-KiribatiIcelanderIndianIndonesianIranianIraqiIrishIrishIsraeliItalianIvorianJamaicanJapaneseJordanianKazakhstaniKenyanKittian and NevisianKuwaitiKyrgyzLaotianLatvianLebaneseLiberianLibyanLiechtensteinerLithuanianLuxembourgerMacedonianMalagasyMalawianMalaysianMaldivanMalianMalteseMarshalleseMauritanianMauritianMexicanMicronesianMoldovanMonacanMongolianMoroccanMosothoMotswanaMozambicanNamibianNauruanNepaleseNetherlanderNew ZealanderNi-VanuatuNicaraguanNigerianNigerienNorth KoreanNorthern IrishNorwegianOmaniPakistaniPalauanPanamanianPapua New GuineanParaguayanPeruvianPolishPortugueseQatariRomanianRussianRwandanSaint LucianSalvadoranSamoanSan MarineseSao TomeanSaudiScottishSenegaleseSerbianSeychelloisSierra LeoneanSingaporeanSlovakianSlovenianSolomon IslanderSomaliSouth AfricanSouth KoreanSpanishSri LankanSudaneseSurinamerSwaziSwedishSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTonganTrinidadian or TobagonianTunisianTurkishTuvaluanUgandanUkrainianUruguayanUzbekistaniVenezuelanVietnameseWelshWelshYemeniteZambianZimbabweanState / Province of Origin *Residential Address *Closest Landmark *Closest Bus Stop *Local Government Area *City *State of Residence *Country *Select your Country of ResidenceAfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChina - Hong Kong / MacauColombiaComorosCongoCongo, Democratic Republic of (DRC)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreat BritainGreeceGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIsrael and the Occupied TerritoriesItalyIvory Coast (Cote d'Ivoire)JamaicaJapanJordanKazakhstanKenyaKorea, Democratic Republic of (North Korea)Korea, Republic of (South Korea)KosovoKuwaitKyrgyz Republic (Kyrgyzstan)LaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar/BurmaNamibiaNepalNew ZealandNicaraguaNigerNigeriaNorth Macedonia, Republic ofNorwayOmanPacific IslandsPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak Republic (Slovakia)SloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandNetherlandsTimor LesteTogoTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited States of America (USA)UruguayUzbekistanVenezuelaVietnamVirgin Islands (UK)Virgin Islands (US)YemenZambiaZimbabweLength of Stay *Accommodation Type *OwnedRentedPrevious Home Address *Email Address *Phone Number *Mode of Identification *National IDNational Driver's LicenceInternational PassportOthersOthers (Please Specify) *Identification Number *Health Insurance Information *YesNoProvider *Number *Name of Spouse *Spouse's Phone Number *Spouse's Email Address *Number of Dependants *NextRegistered Business Name *Company Registration Number *Business Insurance *YesNoProvider *Number *Business Address *City *State / Province *Country *Select a CountryAfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChina - Hong Kong / MacauColombiaComorosCongoCongo, Democratic Republic of (DRC)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreat BritainGreeceGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIsrael and the Occupied TerritoriesItalyIvory Coast (Cote d'Ivoire)JamaicaJapanJordanKazakhstanKenyaKorea, Democratic Republic of (North Korea)Korea, Republic of (South Korea)KosovoKuwaitKyrgyz Republic (Kyrgyzstan)LaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar/BurmaNamibiaNepalNew ZealandNicaraguaNigerNigeriaNorth Macedonia, Republic ofNorwayOmanPacific IslandsPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak Republic (Slovakia)SloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandNetherlandsTimor LesteTogoTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited States of America (USA)UruguayUzbekistanVenezuelaVietnamVirgin Islands (UK)Virgin Islands (US)YemenZambiaZimbabweTelephone (1) *Telephone (2) *Email Address *Tax Identification Number *PreviousNextType of Loan *Working Capital LoanTerm LoanInvoice / Receivables DiscountingLoan Amount (₦) *Tenor *Select1 Month2 Months3 Months4 Months5 Months6 MonthsPurpose of Loan *Repayment Method *Bank DepositDirect DebitChequesRepayment Mode *Bi-MonthlyMonthlyAll at OnceMethod of Disbursal *Pre-Paid CardBank DepositPreviousNextDo you have any existing facilities? *YesNoName of Bank / Finance House *Type of Facility *Repayment Amount (₦) *Repayment Mode *MonthlyQuarterlyYearlyCurrent Outstanding Balance (₦) *PreviousNextBank Account Number *Name of Bank *Account Type *SavingsCurrentOthersOthers (Please Specify) *Bank Verification Number *Name of Signatory *FirstMiddleLastPreviousNextName *FirstMiddleLastBackground Check / Credit Report Check Agreement *I hereby consent to Old Shoreham Lend Assure Limited conducting a background check and / or credit report check on me.This consent is valid for the purposes of verifying information given pursuant to my application for a credit facility in the above named institution / to act as a guarantor for a credit applicant in the above named institution, or any other permissible purpose as stipulated in section 5 of the "Guideline for the Licensing, Operations and Regulation of Credit Bureau and Credit Bureau Related Transactions in Nigeria" in the exercise of the powers conferred on the Central Bank of Nigeria by Section 57 of the CBN Act 2007. The data to be collected shall be used in order to: 1. Determine my identity, banking relationships, overall debt exposure, repayment behaviour and other contractual obligations. 2. Confirm all information provided to Old Shoreham Lend Assure Limited be accurate and valid. I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, country and federal courts and agencies, military services and persons to release all information they may have about me including criminal and driving history. This document shall be valid in original or copy form.Date *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PreviousNextKindly download the Guarantor's Form.Photo Identification *File Types Allowed - .png, .jpg, .pdfCompleted Guarantor's Form *File Type Allowed - .pdf6 Months Business Statement of Account *File Type Allowed - .pdfA Utility Bill Not Older Than 3 Months *File Type Allowed - .pdfNational Form of Identification *File Type Allowed - .pdfCAC Document *File Type Allowed - .pdfTax Identification Card *File Type Allowed - .pdfNameSubmit
