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Credit Application

Credit Application in the name of: Where the application is in the name of a company , please enter all the releveant information such as Name of the Company, Trading Name and/or Trust name.
Surname Name
Marital Status Marital Status

Date of Birth

No. of Dependants

Licence No

Purpose of Loan

Amt. of Purchase Term (months)

Deposit Rate (%)

Trade Amt

Amt. of Loan Payment

Residential Address / Registered Office

Phone

Duration Years Years Months Months

Status Status

Previous Residential Address / Registered Office

Duration Years Years Months Months

Occupation /Nature of Business

Spouse - Occupation (if applicable)

Employer - Name and Address

Phone

Contact name

Duration Years Years Months Months

Previous Employer - Name and Address

Phone

Contact name

Duration Years Years Months Months

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Applicant 1 Monthly Income (After Tax) Other Income (Overtime/Rentals) *Details of other Income Monthly Income (After Tax)

Applicant 2

Other Income (Overtime/Rentals) *Details of other Income

Monthly Expenditure Mortgage/Rent Board Other Mortgage payments Living Expenses Home Expenses (Utilites) Other Expenditure *Details of other Expenditure Mortgage/Rent Board Other Mortgage payments Living Expenses Home Expenses (Utilites) Other Expenditure

Monthly Expenditure

*Details of other Expenditure

Personal Assets Cash In Bank Home Value Other Property Value Motor Vehicles Household Effects Business Assets Term deposits Other Assets *Details of other Assets Cash In Bank Home Value Other Property Value Motor Vehicles Household Effects Business Assets Term deposits Other Assets *Details of other Assets

Personal Assets

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Personal Liabilities Home Mortgage Other Property Mortgage Credit Card (Limit) Overdraft (Limit) Loans Outstanding Other Liabilities *Details of Other Liabilities Home Mortgage Other Property Mortgage Credit Card (Limit) Overdraft (Limit) Loans Outstanding Other Liabilities *Details of Other Liabilities

Personal Liabilities

REFERENCES

Accountant

Phone

Bank

Branch

Account Type

Reference- Mortgage/Landlord/Address

Phone

Personal References

Phone

Nearest Living Relatives

Relationship

Phone

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FINANCE REFERENCES - complete for all applications Name of Financial Institution Branch Account No. Payments Taken Out

I/We are not undischarged bankrupt(s) and there are no unsatisfied judgements against me/us. I/We declare that the information given is true and correct. I/We authorise you to contact any person/company to obtain necessary data.

Applicant 1 Signature :

Applicant 2 Signature :

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