Loan Application

Salutation *

First Name *

Last Name *

Home Number

Mobile Number *

Email Address *

Passport Number

Country of Issue

Date of Birth *

(Note: An applicant must be 18 years older or above to apply.)

Permanent Address *

City *

Country *

Debt Consolidation

2. Assets & Liabilities

Assets (List all items/sums owned)

Liabilities (List all items/sums owned)

Name of Asset	Amount	Name of Bank/Creditor	Purpose	Pay Off	Outstanding Balance	Payments
Cash
Bonds & Stocks
C.S.V. Life Insurance
Real-Estate Owned (Describe below*)
Furniture
Auto
Other
Other			Rent
Other		Subtotal Liabilities
	Total Liabilities
	Net Worth
TOTAL ASSETS		TOTAL LIABILITIES/NETWORTH

Deposit Accounts - Name of Bank	Branch	Amount in Bank	Type of Account

AMOUNT OF LIFE INSURANCE

Applicant

Applicant (Nearest relative with whom not living)

Address

Home Telephone

Work Telephone

Cell Number

Relationship

Applicant (Nearest relative with whom not living)

Address

Home Telephone

Work Telephone

Cell Number

Relationship

Co-Applicant (Nearest relative with whom not living)

Address

Home Telephone

Work Telephone

Cell Number

Relationship

Co-Applicant (Nearest relative with whom not living)

Address

Home Telephone

Work Telephone

Cell Number

Relationship

Landlord (or mortgage holder)

Confirms: Monthly Rental

Years There

Good

Slow

Name of Landlord/Mortgage

Address

Home Telephone

Work Telephone

Relationship (If any)

Comments

Add Property Details

I/We hereby certify all information provided is true and complete. I/We have no other undisclosed financial obligations and acknowledge the foregoing will be used to determine my/our credit-worthiness. I/We consent to the exchange of financial information with other Financial Institutions, Credit Bureaus or Lending Brokers of a credit nature by the Bank at any time and hereby agree to indemnify and save harmless the Bank from all claims from such exchange. I/We agree that if the loan is granted the interest rate thereon will be subject to change without notice. The Bank is authorised to debit all loan payments and charges incurred in perfecting any collateral security taken in support of this loan to my/our deposit account. I/We hereby authorize the bank to use all means at its disposal to validate the veracity of the information we have provided and to use the contact information to communicate with me/us at any time.

Applicant's Signature *

Undo Clear

Date * (Note: The date is in DD/MM/YYYY format.)

Co-Applicant's Signature *

Undo Clear

Date * (Note: The date is in DD/MM/YYYY format.)

Save & Continue

Referances	Latest Update	Date Account Opened	High Credit	Terms	Present Balance	Rating	Other Info.