Land Application Form Personal Data Name Title Select OneMr.MrsMiss Full Name Marital Satus Marital StatusSingleMarried Gender GenderMaleFemaleRather Not Say Nationality Mobile Email Postal Address Residential Address NEXT OF KIN Next Of Kin Name Next Of Kin Email Next Of Kin Mobile EMPLOYMENT DETAILS Next Of Kin Employer Next Of Kin Job Designation Next Of Kin Employers Number PURPOSE OF PURCHASE (PLEASE SELECT) Purpose Of Purchase Options Commercial Educational Residential Other reason for purchase PAYMENT OPTION (Please Tick As Appropriate) Outright Payment Outright Payment Installment Payment Installment Payment options 3 Months 6 Months a. ATTESTATION (Outright) Name hereby affirm all information provided as a requirement for the allocation of land in PRIME COAST, Sanusi Village, Ibeju Lekki, Lagos State is true. Any false or inaccurate information given by me may result in the decline of my application. Signature Signature Date a. ATTESTATION (Installment) Name a subscriber to PRIME COAST hereby acknowledge my obligation to pay on monthly basis, all installments due on my payment plan for the plot(s) I subscribed to. I also acknowledge the right of the Promoters of PRIME COAST to revoke any plot(s) due to me in the event that I fail, refuse or neglect to pay for three (3) consecutive months. I acknowledge that any false or inaccurate information given by me will result to me being disqualified from allotment. Any withdrawal of my interest on the land paid for will only be entertained within 3months of subscription and will attract a 40% administrative charges. I have read and understood all the terms and conditions herein contained and so agree. Signature Signature Date Referred By Realtors Mobile Realtors Email Send
