Step 1 of 10 10% PERSONAL INFORMATIONTitle*MrMrsMissDrChiefFirst Name*Middle NameLast Name*Maiden NameDate of Birth* MM DD YYYY Gender*MaleFemalePrefer Not to SayMarital Status*SingleMarriedSeparatedDivorcedWIdowedNumber of Children*12345Number of Dependents*12345Education Status*PrimarySecondaryGraduatePost Graduate LOAN PURPOSEPurpose of Loan*Consumer LeasesTravel/HolidayMedicalHousehold MaintenanceRentSchool FeesWedding/EventsFashion GoodsDo you have any existing Loan?*YesNoPlease specify*MortgageOverdraftBusiness LoanCar LoanCredit LoanPersonal LoanNumber of Cars Currently Owned*12More than 2Do you have a driver?*YesNoWhich Type of Driver?*PersonalOfficialWho is your Mobile Provider?*MTNGloAirtelEtisalatIs Your Mobile Contract Or Pay As You Go?*ContractPay As You Go LOAN DETAILSLoan Amount Requested*Loan Tenure (Months)Affordable Monthly Repayment* NEXT OF KINFirst Name*Surname*Relationship*Home Address of Next of Kin*Mobile Number* IDENTITY VERIFICATIONMeans of Identification*International PassportNational IDDriver's LicenseDocument Number*Document's Issue Date* MM DD YYYY Document's Expiry Date MM DD YYYY Mobile Number 1*Mobile Number 2*Bank Verification Number (BVN)*Email* Address* Street Address Address Line 2 City State Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country TIme At Current Address*YearsMonthsResidential Status*TenantOwnerWith RelativeWith ParentPrevious Address if resident at Current Address for less than 3years Street Address Address Line 2 City State Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Employment Status*Full TimePart TimeRetiredSelf EmployedStudentTemporary ContractUnemployedHousewifePublicPrivateCurrent EmployerCurrent Employer's Address Street Address Address Line 2 City State Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Employer's Number*Employer's Email* Employer's Website Staff ID NumberPension NumberTax NumberPosition/Job Title At WorkplaceDept. & Unit At WorkplaceDate Employed* MM DD YYYY If present Employment is less than 1yearPrevious EmployerPrevious Employment Address Street Address Address Line 2 City State Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Number of Months in Previous EmploymentPlease enter a number greater than or equal to 1.How many jobs have you had in the last 5 yearsPlease enter a number greater than or equal to 1.Current Net Monthly IncomeCurrent Pay Date MM DD YYYY IndustryAgricultureMilitaryBanking/FinancePowerConstruction/EngineeringPublic SectorEducationReal EstateOil/GasRetail/SaleHealthManufacturingTelecomsMedia/EntertainmentServices Sector (Please Specify)* How did you hear about SAMTL Leasing Limited Loan Products?*LeafletSalesmanOnline (Social Media)SMSRadioTelesalesFriendly ReferralWebsiteNewspaperMagazineWhich Newspaper?*Which Magazine?* Disbursement Details Account Name*Account Number*Bank Name*Bank Branch*Sort CodeCONFIRMATION & ACCEPTANCE 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 applicationsUpload Signature*Date* MM DD YYYY TERMS & CONDITIONS These Terms and Conditions apply to and regulate the provision of credit facilities advance by SAMTL Leasing Limited. These standard Terms and Conditions together with our offer letter set out the terms governing this Loan Agreement. It is important that you read the offer letter and these Terms and Conditions carefully and keep them for the future reference. A. INTEREST 1. Subject to subsection (2) and (3), the Annualized Percentage Rate of Interest (”APR”) for the direct Loan Accounts is in line with the market. 2. SAMTL Leasing Limited may in its sole discretion increase or decrease the prevailing interest rate for any reason and 3. Any change in interest rate will take effect on the Borrower’s account following a minimum of 7 days written notice. 4. All fees will be capitalized into the interest calculation. B. PAYMENTS All payments by the Borrower will be made by personal cheques only. All other methods will be accepted with SAMTL Leasing Limited’s consent only. In Particular: 1. The Borrower will be given a dedicated and customized repayment plan upon approval of the loan application; 2. The Borrower will be expected to make monthly repayments in accordance with the repayment plan. 3. The Borrower will be sent an electronic message or SMS alert two (2) banking days-before each monthly repayment date and the Borrower hereby agrees that such notice shall be conclusively deemed received by the Borrower without need of any further notice. 4. The Borrower hereby agrees that nonpayment of the amount owed by the Payment Due Date shall render the Borrower in default and entitles SAMTL Leasing Limited to take steps to recover the outstanding loan amount in accordance with clause E below. 5. The Borrower may make an early payment of the outstanding loan obligation due hereunder at any time. Where the Borrower prepays on the loan, SAMTL Leasing Limited shall charge a liquidation rate on the outstanding principal. The outstanding principal is the unpaid loan obligation and the interest accrued as of the date of settlement. C. PROVISION OF FINANCIAL INFORMATION At our request, you will be required to provide us with latest financial statements, contingents liability details and any other reasonable information relating to you and/or your financial affairs. D. USE OF CREDIT BUREAU 1. SAMTL Leasing Limited will approach a dedicated Credit Reference Agency for a credit report on the Applicant in considering any application for credit. 2. The Borrower authorizes SAMTL Leasing Limited to access any information available to it as provided by the Credit Agency. 3. The Borrower also agrees that his/her details and the loan application decision will be registered with the Credit Agency. 4. In the event the Borrower wishes to access the credit report, SAMTL Leasing Limited will advise the Borrower of the contact details of the relevant credit agency and the Borrower waives any claims he/ she may have against SAMTL Leasing Limited in respect of such disclosure E. INFORMATION FROM EMPLOYER The Employee hereby consents to SAMTL Leasing Limited requesting and its Employer providing, relevant Employee information to SAMTL Leasing Limited as itemized under the Employer’s Confirmation Section of the application, form as well as, any other information which SAMTL Leasing Limited may require hereunder. F. DEFAULT Default in terms of this Agreement will occur if: 1. The Borrower fails to make repayment in full, on or before the payment date in accordance with the monthly repayment plan given to the Borrower; 2. Any representation, warranty or assurance made or given by the Borrower in connection with the application for this loan or any information or documentation supplied by the Borrower, is later discovered to be materially incorrect; or 3. The Borrower does or omits to do anything which may prejudice SAMTL Leasing Limited’s rights terms of this Agreement or cause SAMTL Leasing Limited to suffer any loss or damage. If the Borrower default in their obligations under this Agreement, SAMTL Leasing Limited will be entitled to do the following a. SAMTL Leasing Limited will on each Repayment Date collect the total amount payable by the date in accordance with the repayment plan schedule given to the Borrower b. Where the Borrower fails to honor their obligation to repay their total monthly repayment amount by the due date, SAMTL Leasing Limited will attempt to collect the outstanding amount within the next twenty-four (24) hours. c. Where more than forty-eight (48) hours have elapsed since the repayment date and the repayment amount (total or partial still remains outstanding, SAMTL Leasing Limited will start calculating accelerated interest at the rate of 30% plus the applicable borrowing interest rate. d. Following the Borrower’s default, SAMTL Leasing Limited reserves the right to assign its right, title and interest under the Agreement to an external collections agency who will take all steps, within the bounds of the law, to collect the outstanding loan amount. e. SAMTL Leasing Limited also reserves the right to start legal proceedings against the defaulting Borrower and is under no obligation to inform the Borrower before such proceedings commence. f. SAMTL Leasing Limited will be entitled to terminate this Agreement (after service of any notice require there under) if the Borrower in any way perpetrates or attempt to or is involed in any act of fraud or other criminal activity in Respect of SAMTL Leasing Limited MFB or the Loan, or if any information provided by Borrower as part of the application is incorrect or misleading in any material manner. on such termination, SAMTL Leasing Limited reserves the right to demand repayment of the full loan amount with interest calculated as stipulated in these Terms and Conditions. Hold the Borrower responsible for all legal costs and expenses incurred by SAMTL Leasing Limited in attempting to obtain repayment of any outstanding loan balance owed by the Borrower. Interest on any amount which becomes due and payable shall be charged in accordance with these Terms and Conditions. COMMUNICATION The Borrower agrees that SAMTL Leasing Limited may communicate with them by sending notices, messages, alerts and statement in relation to this Agreement in the following manner: 1. To the most recent address SAMTL Leasing Limited holds for the Borrower on file 2. By delivery to any email address provided during the application process. 3. By delivery of an SMS to any mobile telephone number the Borrower has provided to SAMTL Leasing Limited MISCELLANEOUS This Agreement shall be governed by the laws of the Federal Republic of Nigeria and shall be subject to the jurisdiction of the courts of the Federal Republic of Nigeria. 1. If SAMTL Leasing Limited does not strictly enforce its rights under this Agreement (including its right to insist on the repayment of all sum due on the Repayment Due Date) or grant the Borrower an indulgence, SAMTL Leasing Limited will not be prevented from insisting upon its strict rights at a later date. 2. SAMTL Leasing Limited reserves the right to transfer or assign its rights and obligation under this Agreement (including its obligation to lend money to the Borrower or the amount owned under this Agreement) to another person. 3. SAMTL Leasing Limited may inform the Borrower of a transfer/assignment of its rights hereunder if such a transfer results in a change in the administration of this Agreement. THIS APPLICATION ALSO SERVES AS AN ACCOUNT OPENING FORM All the terms and conditions in this SAMTL Leasing Limited Loan Application package have been read understood by me. I hereby accept the terms and conditions as evidenced by my signature below First Name*Surname*Upload Signature*Date* MM DD YYYY FOR OFFICIAL USE ONLY (TO BE COMPLETED BY COMPANY'S OFFICIAL)Staff NameID NumberStaff SignatureDate MM DD YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.