CLIENTS INFORMATION Date: Title: Surname Name: Other Names: Phone Number: Email Address: State: -----AbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEdoEkitiEnuguGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfara City: Address: Gender: -----MaleFemale OTHER DETAILS Marital Status: MarriedSingleSeparatedDivorced Nationality: ----NigerianOther Resident Status: ----Resident IndividualNon-ResidentForeigner State of Origin: ----AbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEdoEkitiEnuguGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfara Home Town: Bank Account: Bank Name: EMPLOYEMENT DETAILS Employment Status: ------EmployedSelf EmployedOthers Specify Status if "Others": Occupation: Business Address: INVESTMENT DETAILS Ibharcan FX / Crypto Investment: Quarterly InterestInterest at maturity Regular Naira Investment: Periodic InterestInterest at maturity Cash Invested: Return on Investment: Mode of Payment: ----ChequeDirect DebitElectronic TransferCryptocurrency INFORMATION OF NEXT OF KIN First Name: Middle Name: Surname: Mobile Number: Email address: Home Address: Relationship: Upload ID: (+234) 0703-326-4820 info@ibharcan.com (+234) 0813-635-4251