Land Form | BRICKWALL GLOBAL INVESTMENT LIMITED

Instructions

Please read this form carefully before filling.
All information supplied will be treated with confidetiality; therefore please submit only TRUE information.
The passport photograph to be attached must be a recent copy and must be that of the individual applying
All inquiries should be directed to the Client Management Dept. or Visit any of our office near you.

Estate

Title

First Name

Last Name

Other Names

Date of Birth

Marital Status

Nationality

Subscriber's Tel No.

Contact Address

Address Line 2

Mailing Address

Address Line 2

Next of Kin

Next of Kin's Phone Number

Marketer's Details if any.

Marketer's Tel No.

Acknowledgement and Undertaking

I, a subscriber to the to the Estate, do hereby acknowledge my obligations.

I also Acknowledge the right of Brickwall Global Investment Ltd. the developer of the Estate, to revoke any Plot(s) due to me in the event that I fail, refuse or neglect to pay three consecutive installment payments. Information found to be false will lead to disqualification of the application for allotment. Refund of payment is also unacceptable.

By Checking this Box, I hereby accept the Undertaking Above.

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