IMMIA FINANCE

Customer Portal

Personal Information

Step 3: Complete your personal details

@csrf

Your basic personal information

Title * @error('title')

@enderror

Date of Birth * @error('dob')

@enderror

Surname * @error('surname')

@enderror

First Name * @error('first_name')

@enderror

Middle Name @error('middle_name')

@enderror

Full Name (Auto-generated) * @error('customer')

@enderror

This field is automatically generated from your title, surname, and first name

Your contact details

Mobile Number * @error('phone')

@enderror

Office Telephone No @error('office_phone')

@enderror

Physical Address * @error('address')

@enderror

Town * @error('town')

@enderror

Province * @error('province')

@enderror

Your identification details

Customer Type * @error('cgroup')

@enderror

ID Type * @error('idtype')

@enderror

ID Number * @error('number')

@enderror

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Email & Password

Profile Picture

Personal Info