Queen’s Park Estate Kuje Abuja Application Form

Queen’s Park Estate Kuje’s Application Form
Questions marked by * are required.
1.	Upload Passport Photo *
2.	Title: * Mr. Miss Mrs. Dr. Chief
3.	Surname: *
4.	Other Names: *
5.	Residential Address: *
6.	Date of Birth:
7.	Nationality: *
8.	State of Origin:
9.	Telephone: *
10.	Occupation:
11.	E-mail: *
12.	Postal Address:
13.	Marketer Name/Phone No:
14.	Next of Kin: *
15.	Address (Next of Kin): *
16.	Tel (Next of Kin): *
17.	Payment Terms: * Outright (1,500,000 naira) 18 Months (100,000 naira monthly)
18.	Number of Plots: *
19.	Plot Options: * Residential Commercial
20.	Proposed use of Land: * 4 Bedroom Bungalow 5 Bedroom Duplex
21.	Attestation: * I hereby affirm that the information provided above in partial fulfillment of terms of purchase of the Estate’s Plot(s) of Land is true. I accept that any default in paying my monthly subscription for three consecutive months will result in immediate revocation of my plot(s) and refund of any money paid less 20% administrative charge and 10% agency fee where applicable. All instruments of payment (Cash, Cheque, Bank Drafts) should be made in favour of Landmark Corporate Realty Ltd to our GTBank Account number: 0017136776 Agree Disagree