MORTGAGE 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 Date of Birth
Status Single Married Others (specify)
(DD MM YYYY)
Nationality Mobile Phone
E-mail Address
Residential
Address
(Not P.O Box)
Resident Length of Time at
Owned Rented Staying with Family Others Month(s) Year(s)
Current Address
Type
Highest Educational
Quali�cation
Mode of Identi�cation Nat. ID NDL Others (specify)
Identi�cation Number
Name of Spouse Spouse’s Mobile Phone
Bank Veri�cation Number (BVN)
Part 2: Business Information (Business Entrepreneurs)
Registered Business Name
Registration Number
Trading Name
Business Address
City State
Telephone
Email Address
Brief Description of
Customer’s Business
Part 3: Employee Information (To be completed by employee)
Job Title Sta� ID No.
Employer's Name
O�ce E-mail
O�ce Phone Number
O�ce Address
Industry: Oil & Gas Manufacturing Transportation Governmental Parastatal
Others
Cadre/Level
Number of Years in Current Employment
Date of Employment Con�rmed Status: Con�rmed Probation
(DD MM YYYY)
Annual Income (₦) Terminal Bene�ts (₦)
Monthly Income (₦) Salary Due Date
(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 This undertaking shall be a continuing and irrevocable obligation and shall not be withdrawn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/-
con�rmation 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 con�rm 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 bene�ts 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 noti�cation of resignation, transfer, dismissal or termination of the
employee, the receipt by the Bank of the employee’s terminal bene�ts along with an advice regarding same shall su�ce.
Name
Designation
Authorized Signatory Date
(DD MM YYYY)
O�cial Stamp
Name
Designation
Authorized Signatory Date
(DD MM YYYY)
O�cial Stamp
Part 6: Loan Request Details (Individual and Corporate Customers)
Loan Amount (₦)
Loan Amount
in words (₦)
Equity Contribution (₦) Tenor(months)
Access Bank Access Bank
Account No. 1 Account No. 2
* [Please note that this is for individuals whose
* Repayment Method: Direct Debit Bank Standing Order Salaries are not domiciled in Access Bank]
Part 7: Insurance Premium Financing Option
Would you like the Insurance Premium Finance Product as an additional facility Yes No
Insurance Premium Amount
Amount in words
Equity Contribution
Part 8: Mortgage Details
Product Type: Home purchase Equity Release O� Plan Mortgage
Open Market Value (OMV) Forced Sale Value (FSV)
Type of Property Terrace Bungalow Flat Duplex Others
Part 9: Existing Facilities with Access Bank and other Lenders/Employer
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 and 5. I/we am/are aware that the rate of interest and monthly repay-
conditions attached hereto. The acceptance of your application for ments of any variable rate facility granted may be varied from
a loan shall be at the discretion of the Bank and we shall not be time to time.
obliged to furnish reasons to you should your application not be
accepted. If we accept your application, we will let you know in 6. I/we undertake to notify the Bank immediately in writing of any
writing. situation which materially changes the representation of this
application, and I/We understand that the Bank may amend or
1. I/we am/are at least 21 years of age withdraw any offer previously made.
2. I/we con�rm that all the details given in this application are true 7. I/we understand that Access Bank will disclose my/our details to
and complete and I/we understand that these will be used to any Access Bank's insurers, auditors, professional advisers, or
form the basis of any facility o�ered. any persons providing services to Access Bank who have agreed
to treat my/our personal details as confidential, or if required to
3. I/we authorise you to conduct any enquiry you consider do so by law or any relevant regulatory body, as envisaged by this
necessary and appropriate for the purpose of evaluating this application form or with my/our written consent.
application from my/our employer, if any and from any other
source to which you may apply including a credit search with one 8. I/we acknowledge that Access Bank may at any time transfer
or more credit reference agencies and con�rm that I/we am/are Access Bank's interest in the facility, together with any security
not currently under administration, sequestration, debt review, I/we give, to any other lender, bank or institution, without first
or a restructuring order. seeking my/our permission and I/we authorize Access Bank to
disclose any information which Access Bank holds/ possesses
4. I/we accept that at any time before any facility o�ered to me/us about me/us to such entity.
is completed; Access Bank may withdraw, revise, or cancel such
o�er. 9. I/We hereby authorise the Bank to disclose any and all
information in respect of my/our account to the guarantors for
as long as the guarantor’s liability of the debt outstands.
10. I/we agree that by taking up all or part of any facility offered by 12. I/we have personally completed this application form, or if
Access Bank on the basis of the information provided on this completed by someone else, have read and checked every
application form and by signing this form, I/we agree to accept answer and I/we have appended my/our signature fully under-
all the conditions set out in Access Bank's facility offer letter. standing the implication of the words and terms so contained.
I/we agree that if I/we receive more than one letter, the letter
showing the latest date will be that which applies. 13. I/we commit that this facility shall not be utilized for any acts of
terrorism or other related acts. I/We hereby confirm my / our
11. I/we understand that the Bank may set off any amounts due application for the above facility and certify that all information
under the agreement against any sums owing by me/us to provided by me/ us above and attached thereto is correct and
Access Bank (whether jointly or severally) and otherwise complete. The facility shall not be utilized for any act of terrorism
combine and consolidate all or any of my/our accounts with or other illegal or prohibited acts.
Access Bank at any branch of the Bank and whether current, I / We authorize you to make any enquiry you consider neces-
deposit, loan, or any other nature and whether accounts in sary and appropriate for the purpose of evaluating this applica-
my/our name or jointly with others and whether in any other tion.
currency. Any currency conversions required to be effected by
Access Bank in pursuant to this right shall be effected in accor-
dance with the usual practice of the Bank.
1. Name of Signatory
Date
Signature of Applicant (DD MM YYYY)
2. Name of Signatory
Signature of Applicant Date
For Additional Signatory) (DD MM YYYY)
