Intafact Logo
10th December 2018
Intafact Logo

Online Form

Hero Kickstart Programme
  • Section 1: Basic Information
    APPLICANT'S DETAILS

    0
  • First Name*enter your first name
    1
  • Surname*enter your surname
    2
  • Other Names*enter your other names
    3
  • Type of ID*select a valid form of identification
    4
  • ID No.*enter the ID number of your identification card
    5
  • Gender*select your gender
    6
  • Date of Birth.
    Choose from the options below
    7
  • Day*
    8
  • Month*
    9
  • Year*
    10
  • Email*a valid email address
    11
  • Contact Address*enter your contact address
    12
  • State of Residence*select a state where you currently reside
    13
  • State of Origin*enter your state of origin
    14
  • Phone (mobile)*enter a valid telephone number
    15
  • Educational Qualification*enter the level of education you have attained
    SSCE
    OND
    HND
    Bsc
    Msc
    Others
    None
    16
  • How did you hear about Kickstart programme?*
    18
  • Section 2: Business Information

    20
  • Business Type*select which best describes your business
    21
  • Passport Photograph*upload a passport photograph here (Max filesize 2MB)Upload
      37
    • *
      I affirm that all the information provided on this application form is correct and true.
      38
    • 39
    Top