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REPAC COOPERATIVE APPLICATION FORM
Pay into this account:
Fidelity Bank
Viva-Gold Real Estate Ltd
5601284434
Client's Full Name
Client's Email Address
Client's Phone Number
Client's Date of Birth
Gender
Male
Female
Client's Marital Status
Single
Married
Client's Country
Client's State
Client's City
Client's Address
Amount Invested
Client's Bank Name
Client's Account Name
Client's Account Number
Duration
12 months
24 months
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Upload Evidence of payment here
Upload a valid ID card
Upload Utility Bill
Date on Evidence of Payment
Pls confirm you have read and understood the FAQ. Use this link- (https://bit.ly/repacfaq)
Next of Kin Beneficiary
Relationship To Next Of Kin
Next of Kin - Address
Next of Kin - Phone Number
Realtors' Full Name
Realtor's Email Address
Realtor's Phone number
Realtor's CID
Instruction if any
Send
