PERSONAL LOAN APPLICATION FORM

Please complete in BLOCK LETTERS.

Bank Use
Processing Branch Code Staff/Direct Sales ID Date dd mm yy

AO Name Signature

CSM Name Signature

SECTION A - LOAN APPLICATION DETAILS

Part 1: Personal Information (Individual Customers)

Title Mr Mrs Others (specify) Male Female

Name
(Surname) (First Name) (Other Names)

Marital
Others (specify) Date of Birth
Single Married
Status (DD MM YYYY)

Nationality Mobile Phone

E-mail Address

Residential
Address
(Not P.O Box)
Resident
Length of Time at
Owned Type Rented Staying with Family Others Current Address Month(s) Year(s)

Highest Educational
Qualification

Mode of Identification
Nat. ID NDL Others (specify)

Identification Number

Name of Spouse Spouse’s Mobile Phone

Bank Verification Number (BVN)

Part 2: Loan Request Details

Loan Amount (₦)

Loan Amount
in words (₦)
Tenor(months)

Access Bank Access Bank

Account No. 1 Account No. 2

Part 3: Employee Information (To be completed by employee)

Job Title Staff ID No.

Employer’s Name

Office E-mail

Office Address

Industry: Oil & Gas Manufacturing Transportation Governmental Parastatal

Others

Cadre/Level

Number of Years in Current Employment

Date of Employment Confirmed Status: Confirmed Probation

(DD MM YYYY)

Annual Income (₦) Terminal Benefits (₦)

Salary Due Date

Monthly Income (₦) (DD MM YYYY)

Part 4: Employee Authorization (To be completed by employee)

I __________________________________________________________ hereby certify that the above information given by me

is correct to the best of my knowledge and irrevocably undertake, covenant and agree that my employer should domicile my
salary and allowances to Access Bank Plc. This undertaking shall be a continuing and irrevocable obligation and shall not be
withdrawn by me until my obligations, indebtedness or liabilities to the bank have been fully settled, as evidenced by the
written consent/confirmation of Access Bank.

Authorized Signatory Date

(DD MM YYYY)

Part 5: Employer Undertaking (To be completed by employer)

In consideration of a loan facility request by our employee to Access Bank PLC, we hereby confirm that all information
provided by the applicant above is true.

We undertake and covenant to (1) To domicile the salary account of the employee with Access Bank for the entire duration of the
facility. (2) To domicile with Access Bank all monetary/terminal benefits due from us to the employee upon the employee ceasing to
remain in our employment (3) To inform the bank within two (2) working days of resignation, or transfer or dismissal or termina-tion
of the employee. We agree that in the absence of a notification of resignation, transfer, dismissal or termination of the employee, the
receipt by the Bank of the employee’s terminal benefits along with an advice regarding same shall suffice.

Name
Designation

Authorized Signatory Date

(DD MM YYYY)

Official Stamp

Name

Designation

Authorized Signatory Date

(DD MM YYYY)

Official Stamp

Part 6: Existing Facilities with Access Bank and other Lenders/Employers

Name of Bank/Organisation Type of Facility Repayment Amt Repayment frequency Current Outstanding
S/No
(Including Access Bank) (including Credit Cards) (monthly, Quarterly, Yearly) Balance

1.

2.

3.

4.
Declarations
You make the following declarations to us:
The Loan is governed by this application form, and the Terms 9. I hereby authorise the Bank to disclose any and all
and conditions attached hereto. The acceptance of your information in respect of my account to the guarantors for
application for a loan shall be at the discretion of the Bank and as long as the guarantor's liability of the debt outstands.
we shall not be obliged to furnish reasons to you should your
application not be accepted. If we accept your application, we 10. I agree that by taking up all or part of any facility offered by
will let you know in writing. Access Bank on the basis of the information provided on
this application form and by signing this form, I agree to
1. I am at least 21 years of age accept all the conditions set out in Access Bank's facility
offer letter. I agree that if I receive more than one letter,
2. I confirm that all the details given in this application are the letter showing the latest date will be that which applies.
true and complete and I understand that these will be used
to form the basis of any facility offered. 11. I understand that the Bank may set off any amounts due
under the agreement against any sums owing by me/us to
3. I authorize you to conduct any enquiry you consider Access Bank (whether jointly or severally) and otherwise
necessary and appropriate for the purpose of evaluating combine and consolidate all or any of my/our accounts with
this application from my/our employer, if any and from any Access Bank at any branch of the Bank and whether current,
other source to which you may apply including a credit deposit, loan or any other nature and whether accounts in my
search with one or more credit reference agencies, and name or jointly with others and whether in any other currency.
confirm that I am not currently under administration, Any currency conversions required to be effected by Access
sequestration, debt review, or a restructuring order. Bank in pursuant to this right shall be effected in accordance
with the usual practice of the Bank.
4. I accept that at any time before any facility offered to me is
completed; Access Bank may withdraw, revise or cancel 12. I have personally completed this application form, or if complet-ed
such offer. by someone else, have read and checked every answer and I
have appended my signature fully understanding the implication
5. I am aware that the rate of interest and monthly repayments of any of the wordings and terms so contained.
variable rate facility granted may be varied from time to time.

13. I commit that this facility shall not be utilized for any acts of
6. I undertake to notify the Bank immediately in writing of any terrorism or other related acts.
situation which materially changes the representation of
this application, and I understand that the Bank may
amend or withdraw any offer previously made. I hereby confirm my application for the above facility and certify
that all information provided by me above and attached thereto is
7. I understand that Access Bank will disclose my details to any correct and complete. The facility shall not be utilized for any act
Access Bank's insurers, auditors, professional advisers or any of terrorism or other illegal or prohibited acts.
persons providing services to Access Bank who have agreed I authorize you to make any enquiry you consider necessary
to treat my personal details as confidential, or if required to do and appropriate for the purpose of evaluating this application.
so by law or any relevant regulatory body, as envisaged by
this application form or with my written consent.

8. I acknowledge that Access Bank may at any time transfer

Access Bank's interest in the facility, together with any
security I give, to any other lender, bank or institution,
without first seeking my permission and I authorize Access
Bank to disclose any information which Access Bank
holds/ possesses about me to such entity.

1. Name of Signatory

Date
Signature of Applicant (DD MM YYYY)