::: NIGERIA CUSTOMS SERVICE ONLINE APPLICATION FORM :::

BVN *

Account Name *

Prefix Surname Other Name

Gender *

Marital Status *

Date of Birth *

Home Address *

Phone *

Means of Identification *

Nationality

State of Origin *

Local Government Area (Lagos State) *

Local Government Area (Abia State) *

Local Government Area (Adamawa State) *

Local Government Area (Akwa Ibom State) *

Local Government Area (Anambra State) *

Local Government Area (Bauchi State) *

Local Government Area (Bayelsa State) *

Local Government Area (Benue State) *

Local Government Area (Borno State) *

Local Government Area (Cross River State) *

Local Government Area (Delta State) *

Local Government Area (Ebonyi State) *

Local Government Area (Edo State) *

Local Government Area (Ekiti State) *

Local Government Area (Enugu State) *

Local Government Area (FCT State) *

Local Government Area (Gombe State) *

Local Government Area (Imo State) *

Local Government Area (Jigawa State) *

Local Government Area (Kaduna State) *

Local Government Area (Kano State) *

Local Government Area (Katsina State) *

Local Government Area (Kebbi State) *

Local Government Area (Kogi State) *

Local Government Area (Kwara State) *

Local Government Area (Nasarawa State) *

Local Government Area (Niger State) *

Local Government Area (Ogun State) *

Local Government Area (Ondo State) *

Local Government Area (Osun State) *

Local Government Area (Oyo State) *

Local Government Area (Plateau State) *

Local Government Area (Rivers State) *

Local Government Area (Sokoto State) *

Local Government Area (Taraba State) *

Local Government Area (Yobe State) *

Local Government Area (Zamfara State) *

Personal Email Address

example@example.com

Mother's Maiden Name *

Customer house description (KYC) *

Land Mark *

Work Division *

Division Address *

Length of Service *

Mobile Number *

IPPIS Number *

Service ID Card No *

Date of Employment *

Date of Retirement: *

Rank *

Annual Income *

Net Monthly Income *

Bank Name (Salary Account) *

Current Account? *

Account Number *

Pay Date *

Name *

First Name Last Name

Address (Next of Kin) *

Relationship *

Phone

Loan Amount Required *

Monthly Repayment *

Tenor *

Name of Bank or Institution

Principal Amount

Outstanding Balance

Monthly Payment

1

2

3

4

5

6

7

8

9

10

Documents to be uploaded

Service ID Card
2 Passport in uniform
3 Month Bank Statement (Most Recent)
Utility Bill

Browse Files

Account Officer's Name

Account Officer's Email Address

example@example.com

How did you hear about us

For official use only

Account Number:...............................................................................................................................

Account Officers Name:...................................................................................................................................

Head, Business Development:...................................................................................................................................

Head, Credit & Risk Mgt:...................................................................................................................................

Internal Control:...................................................................................................................................

Head, FINCON:...................................................................................................................................

Approve by:...................................................................................................................................

APPLICANT INFORMATION

EMPLOYMENT INFORMATION

NEXT OF KIN

LOAN DETAILS

OTHER LOANS, DEBTS OR OBLIGATIONS