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APPLICATION FORM
Profile
Next of Kin
Purchase Details
Title (Mr/Mrs/Miss)
Choose...
Mr
Mrs
Miss
Dr
Professor
Engineer
Chief
Surname
Other Names
Email Address
Phone Number
Contact Address
Nationality
-- select one --
State of Origin
-- select one --
Occupation
Means of Identification
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National ID Card
Voter's Card
International Passport
Drivers' License
Others
Select Identification Document
Choose file...
Select an Identification Document
Select Passport Photo
Choose Passport Image...
Select Passport Photo
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Name of Next of Kin
Phone Number
Address of Next of Kin
Relationship
Next
Purpose For Which Land is Required:
Residential
Commercial
Desired Payment Plan:
Outright
Installment
Number of Plots Subscribed:
Size of Plot Required:
450 SQM
900 SQM
Would You Like Vitatok Nigeria Limited to Construct For You:
Yes
No
If you select No, a Building Engineer will be provided by the company to supervise construction and all expenses to be agreed upon with the Management.
How Did You Find Out About Us:
Website
Media
Newsletter
Agent
Others
Name of Agent
Phone Number
I hereby affirm that the information provided in partial fullfilment of the terms of purchase is true. I understand that it is an offence to make false statements and any allocations granted to me on the basis of such false information may result in revocation
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