Medical & Healthcare Financing

Personal & Patient Details

Full Name (as on ID) *

Phone Number *

Email Address *

BVN (Bank Verification Number) *

Medical Purpose / Care Category *

Full Residential Address *

Employment & Income Details

Employment Status *

Employer Name (or Business name)

Job Title

Monthly Income *

Years in Current Role

Required Document Uploads

Valid Government-issued ID *

Upload ID (NIN, Passport, License)

Selfie Holding ID *

Upload Selfie Holding ID

Last 6 Months Bank Statements *

Upload Statements (PDF/Zip)

Recent Utility Bill *

Upload Utility Bill

Healthcare Business & Corporate Details

Director / Administrator Full Name *

Director's BVN *

Official Facility Phone Number *

Official Facility Email *

Healthcare Business Category *

Corporate Document Uploads

CAC Certificate of Incorporation *

Upload Certificate (PDF/Image)

Board Resolution Authorizing Financing *

Upload Signed Board Resolution

Last 6-12 Months Business Bank Statements *

Upload Bank Statements (PDF/Zip)

Audited Financial Statements (Last 2 Years) *

Upload Financials (PDF/Zip)

Tax Clearance Certificate *

Upload Current Tax Certificate

Recent Utility Bill (Facility Location) *

Upload Utility Bill

Medical Financing Specifications

Financing Amount Requested (₦) *

Initial Down Payment / Deposit (₦) *

By Submitting, I consent to sharing my medical financing application with licensed healthcare financing partners for credit assessment and medical coverage authorization.

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Personal & Family Care

Healthcare Facilities