Consumer Finance Application Form Personal Loan (Page 3 of 5) in pdf

4. Statement of Financial Position

Assets and Liabilities as on:

Assets

Liabilities

Bank’s Use

Assets (amount in NPR)

Liabilities (amount in NPR)

Only

Deposits:

Loan from Laxmi Bank

With Laxmi Bank

With Other Financial Institution

Loan from Other Financial Institution

Shares & Securities:

Loan from Employer

Shares of Listed Companies

Credit Card Limit

Governmental Securities

Other Investments

Other Liabilities:

Furniture , Fixtures and Home

Appliance

(TV, Refrigerator, Computer etc.)

Motor Vehicles:

Year of Manufacture :

________

Model:

________

Real Estate:

a. Self Occupied: State details?

b. Other Assets: State details?

Miscellaneous. Assets: (Jewellery, )

Total Assets:

Total Liabilities:

Net Worth:

Monthly Income and Expediture

Income

Expenditure

Bank’s Use

Income (amount in NPR)

Expenditure (amount in NPR)

Only

Loans Repayment (existing loans)

Salary

Food Expenses

Business Income

Rent

Spouse’s Salary/ Income

Rental Income

Utilities (Electricity, Water, Tel etc.)

Clothing

Dividends

Education

Interest

Medical Expenses

Others (Please specify)

Property/ Income Taxes

Insurance Premium

Transportation

Entertainment (Tours, Outing etc.)

Vehicle Expense (Fuel, Maintenance etc.)

Others (Please specify)

Total Income:

Total Expenditure:

Monthly Net Savings:

Certification and Authorisation:

I/ We hereby declare that all the particulars and information given in the application form are true, correct, complete and up-to-date in all respects and

I/ We have not withheld any information.

I/We hereby authorize Laxmi Bank to obtain verification of my/ our past and present employment earning

records, as well as bank accounts, stock holdings and any other asset balances that are needed to process my/our loan application. In addition, I/ We

authorize Laxmi Bank to order a credit information bureau report and to verify other credit information, including past and present home loan or rental

payment history. It is my/ our intention that a photocopy of this signed form will also serve as authorization to provide Laxmi Bank with the

verifications requested. This information will only be used in the processing of my/our application for a loan.

I understand and agree that the Bank reserves the right to decline my/our application without assigning any reason whatsoever.

Applicant Signature:______________ Date:______________

Co-applicant Signature:______________

Date:______________