Proposed Business Name - Option 1

Proposed Business Name - Option 2

Business Type Business Name Limited Liability Company NGO / Incorporated Trustees

Business Commencement Date

Email Address

Phone Number

Principal Place Of Business

State

Local Government Area (LGA)

City/Town/Village

Post Code

House Number / Building Name

Street Name

Branch Address (if any)

Branch State

Branch LGA

Branch City

Branch House Number / Description

Branch Post Code

Branch Street Name

Surname

First Name

Other Name

Date of Birth

Gender -- Select Gender -- Male Female Other

Occupation / Description

Means of Identification (Type) NIN Driver’s License International Passport Voter’s Card Others

National Identity Number(NIN number)

Document Requirements for Business Name (Max 3MB per file)