Car Loan Application Form Page 2
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1
2DOLLAR VALUES ONLY
FINANCIAL INFORMATION (CONTINUED)
DOLLAR VALUES ONLY
&
ASSETS & LIABILITIES
MONTHLY INCOME
EXPENDITURE
1
2
Total
Assets
1
2
Total
Gross Salary
Bank a/c
Fixed Allow.
Unit Trust a/c
Commissions
Credit Union
Self Employed
Fixed Deposit
Other Income
Shares
TOTAL INC.
Motor Vehicle
Monthly Exp.
Real Estate
PAYE
Total Assets
NIS & Hlth Schg
Liabilities:
Pension
Loans
Savings
Credit Cards
Ins. Premium
Mortgage
Mortgage
Total Liab.
Rent
Bank Loans
Net Worth
Sou Sou
NOTES:
Grocery
Telephone
Cable
Electricity
Entertainment
Car/Travel
Maid
Alimony
Child Mtce.
Total Exp.
Surplus
State where the downpayment is to be paid from
___________________________________________
Terms and Conditions
(1.)
All statements contained in this of application for a loan/lease/mortgage from the Company are true and complete, and were made
for the purpose of obtaining such loan/lease/mortgage, and such application includes the express representation that I am not
being sued, that there is no unsatisfied judgement against me and that I am not indebted to any other lending institution except as
shown within application.
(2.) I undertake to notify the Company immediately on any situation which materially changes the representation of this application.
(3.) The Company shall have power to charge any deposit account which I presently maintain or shall maintain in the event that the
loan becomes delinquent and is not being paid and I agree to pay the usual Company charges and all
costs,
charges
and
expenses which the Company may pay or incur in stamping, perfecting, or enforcing this agreement or obtaining payment or
discharge of my loan/lease/mortgage according to the terms of my promissory note/mortgage bill of sale/ lease
agreement/mortgage deed.
(4) That I have not been bankrupt, insolvent, or made any arrangement with my creditors.
(5.) That any mis-statement of facts herein shall entitle the Company to cancel the loan or to require immediate payment of the
outstanding balance inclusive of interest.
(6.) That I hereby authorise and consent the Company to obtain, give to, share and exchange credit and other information about myself
with others, including credit bureaus, credit insurers, registries, and other persons with whom you have financial dealings, as well
as any other person, as may be permitted or required by law. I jointly and severally agree to indemnify you against any loss claims,
damages, liabilities, actions and proceedings, legal and or other expenses which may be directly or reasonably incurred as a
consequence of such disclosure on your part.
***Please note: where the singular is expressed it is meant to include as well the plural***
Signed at
this
day of
20
__
Applicant’s Signature
Date
Witness’s Name & Signature
Date
Co Applicant’s Signature
Date
Witness’s Name & Signature
Date
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