Consumer Finance Application Form Personal Loan Page 5
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5Introduction/ Reference
Relationship with
Introducer/ Referee
Name:
the Applicant:
Address:
Residence Telephone:
Office Telephone:
Mobile No.:
Occupation:
Signature of
Introducer / Referee:
Applicable only for Gaurantor(s)
Details of Gaurantor(s)
Relationship with
Name:
the Applicant:
Occupation:
Mailing Address:
Residence Address:
Residence Telephone:
Office Telephone:
Email:
Mobile No.:
Assets
Type
Area/ Description/ Location/ Company
Value
Real Estate
Investment in Shares and Securities
Other Marketable Securities
Bank Deposits/ Cash
Vehicles
Total Assets
Liabilities
Description
Value
Type
Loan from Financial Institutions
Loan from Other Sources
Other Payable
Total Liabilities
Net Worth
I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s)
on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the informa-
tion contained in this application may result in civil liability and/or criminal penalties.
Signature of Applicant(s):
1.
_______________
2.
_______________
Signature of Guarantor (if applicable):
3.
_______________
4.
_______________
Place:
_______________
Date: _______________
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Parent category: Financial