Subscription Application Form

Bourdillon County — your peaceful haven

Please read this form carefully before filling it.
Answers are recorded in BLOCK LETTERS.
Please supply accurate information (all information is treated as confidential).
The passport photo must be recent and reflect your true likeness (or that of the authorizing officer).
Direct enquiries to Bourdillon County.
Names will appear on your title documents as filled on this form. Any later alteration attracts ₦15,000.
Filling this form without payment of deposit does not create any obligation between subscriber(s) and Bourdillon County.

Applicant Type

Personal Information

Title

Surname *

First name *

Other name

Address *

Date of birth

Marital status

Phone no. *

Alternative phone

Email *

Nationality

Maiden name

Next of Kin Information

Name

Phone

Employer's Information

Employer

Designation

Phone no.

Address

Relevant Documents

All three are required. PDF or image, up to 10MB each.

Passport photograph *Tap to choose a fileValid ID (International Passport, NIN or Driver's licence) *Tap to choose a fileProof of residence (utility bill, last 3 months) *Tap to choose a file

Land Details

Number of plots reserved/purchased *

Plot size(s) *

Purpose of purchase *

Source(s) of Fund

Others (please specify)

Undertaking / Agreement

Estate / scheme subscribed to

Instalment frequency

I, ________, a subscriber to Bourdillon County, do hereby acknowledge my obligation to pay on a weekly/monthly basis, all instalments due in reference to my payment plan for the plot(s) I subscribed to.

I also acknowledge that Luxage Investments & Properties Ltd reserves the right to revoke any plot(s) allotted to me in the event that I fail, refuse or neglect to pay for three (3) consecutive months.

I acknowledge that if any information I supplied is found to be false, I will be disqualified from allotment. Any withdrawal of my interest on the land paid for will be entertained within 3 months of subscription and will attract a 10% severance and 30% administrative charge respectively. I have read and understood all the terms and conditions herein contained and agree.

I have read, understood and agree to the above.

Applicant's signature *

Date

In the presence of (witness)

Name

Occupation

Address

Witness signature

Date

Realtor (if referred)

Realtor's name

Realtor's phone

Realtor's email