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Firstname:

Lastname:

Middlename:

Phone number:

Date of Birth:

Gender: Male Female

Disability type:

Residential Address

State:

LGA:

BVN:

Bank name:

Bank Account name:

Bank Account number:

Cluster location:

Association:

Trade type:

Trade subtype:

Date enumerated:

Next of kin firstname:

Next of Kin lastname:

Next of kin Phone:

Guarantor firstname:

Guarantor lastname:

Guarantor Phone:

ID Type:

ID Number:

ID Expiry Date:

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Enabling Trade through Transparent Micro-Credit