Loan Application Form – DOCIM Multipurpose Cooperative Society

Apply For A Loan

Loan Application Form

Surname*

First Name*

Middle Name

Email Address*

Phone number*

Alternative Phone Number

Please select

Please select
Yes
No

Are you a registered DOCIM Member?*

Full name of your surety (must be a registered DOCIM member)*

Your DOCIM Cooperative Registration Number*

Your House Address*

Your Office Address*

How much loan do you want? (in words)*

Loan amount in figure*

Please select

Please select
1
2
3
4
5
6

Loan repayment period (6months max)*

Purpose for the loan*

health, education, business etc

Attach your collateral document (if any)

Upload

Select

Select
Access Bank
Fidelity Bank
FCMB
First Bank
GTB
Union Bank
UBA
Zenith Bank
Citibank
Ecobank
Keystone Bank
Optimus Bank
Polaris Bank
Stanbic IBTC
Standard Chartered
Sterling Bank
Titan Trust Bank
Unity Bank
Wema Bank
Globus Bank
Parallex Bank
PremiumTrust Bank
Providus Bank
SunTrust Bank
Signature Bank
Jaiz Bank
Lotus Bank
TAJ Bank
FairMoney Microfinance Bank
Sparkle Bank
Kuda Bank
Moniepoint Microfinance Bank
Opay
Dot Microfinance Bank
Palmpay
Rubies Bank
VFD Microfinance Bank
Mint Finex MFB
Mkobo MFB
Raven Bank
Rex Microfinance Bank

Bank Name*

Account Name*

Account Number*

Fill in any extra information

Declaration:*

I acknowledge that all the information provided above are correct to the best of my knowledge.
I have also read and understood the terms and conditions in the Cooperative's guidelines and bye-laws. I promise to keep to the mutual agreement between me and DOCIM Cooperative Society.
I agree to face the consequences as provided in the loan guidelines and bye-law if I default in any way.