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Customer Details
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Bio-data
Surname
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First Name
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Other Name
Gender
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-- select gender --
Male
Female
Date of Birth
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Expected format: DD-MON-YYYY
Marital Status
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-- select status --
Single
Married
Country of Residence
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-- select country --
NIGERIA
BENIN
CAMEROON
CANADA
COTE D'IVOIRE
FRANCE
GERMANY
GHANA
ITALY
KENYA
SENEGAL
SIERRA LEONE
SOUTH AFRICA
SPAIN
TOGO
UNITED KINGDOM
UNITED STATES
State of Residence
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-- select 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
FCT
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
State of Residence
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City
Phone Number
National Identification Number (NIN)
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E-mail Address
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Address of Residence
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Next of Kin
Last Name
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First Name
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Other Name
Gender
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-- select gender --
Male
Female
Relationship
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-- select relationship --
Parent
Subsidiary
Partners
Brother
Cousin
Daughter
Daugther
Father-In-Law
Husband
Mother-In-Law
Sister
Son
Wife
Mother
Country
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-- select country --
NIGERIA
BENIN
CAMEROON
CANADA
COTE D'IVOIRE
FRANCE
GERMANY
GHANA
ITALY
KENYA
SENEGAL
SIERRA LEONE
SOUTH AFRICA
SPAIN
TOGO
UNITED KINGDOM
UNITED STATES
City
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Phone Number
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Email Address
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Address
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Bank Details
Bank Name
(Value Required)
-- select bank name --
Access Bank
Citibank Nigeria
Diamond Bank
Ecobank Nigeria
Enterprise Bank
Fidelity Bank
First Bank Nigeria
First City Monument Bank
Guaranty Trust Bank
Heritage Bank
Key Stone Bank
Mainstreet Bank
Providus Bank
Skye Bank
Stanbic IBTC Bank
Standard Chartered Bank Nigeria
Sterling Bank
Suntrust Bank Nigeria
Union Bank Of Nigeria
United Bank For Africa
Unity Bank
Wema Bank
Zenith Bank
Bank Account Name
(Value Required)
Account Number
(Value Required)
BVN
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How did you hear about us
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How did you hear about us
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