APPLIANCE TRADERS LIMITED LOAN APPLICATION ITEM PURCHASED:
MONTHLY INSTALLMENT:
TERM:
PERSONAL INFORMATION Title:
Mr.
Ms. Mrs. Dr. Prof.
Surname Name:
□ Male
Gender: First Name:
Date of Birth (dd/mm/yyyy):
□ Female
Middle Name:
Maiden/Alias Name:
Age:
Nationality:
Parish:
Country:
Current Address: Postal Code: Directions: Residential Status (Circle applicable response): [Owner (paying mortgage) ] [ Owner (fully paid for)] [ Family Residence] [ Renting ] [ Living with Parents] [ Leasing/Sharing] [ Other] Number of Years at Address:
Landlord Name:
Landlord Phone#:
Parish:
Country:
Parish:
Country:
Delivery address (If Different) : Postal Code: Previous Home Address: Postal Code: Number of Years at Previous Address: Marital Status (Circle applicable response):
Proof of Address: [Current Utility Bill ] [ Mortgage/Rent Receipt ] [ Single ]
[ Married ]
[ Divorced ]
[ Separated ]
[ Common Law ]
[Other ]
[ Widow]
Number of Dependents: CONTACT INFORMATION Email Address: Phone#:
Home#:
(Circle applicable response)
[Driver’s License ]
Work#: [ Passport ] [ Voter’s/National ID]
Exp Date:
ID# :
(dd/mm/yyyy):
TRN #: Employment Status (Circle applicable response):
[ Employed ]
[ Self Employed ]
Current Occupation:
[ Unemployed ]
[ Student ]
[ Retired ]
Employer:
Supervisor Name:
Employed Since:
Employer Address:
(dd/mm/yyyy) :
Previous Occupation:
Employer:
Supervisor Name:
Time at Previous Employment:
Employer Address: INCOME DETAILS
Bank Name: Bank Loan: [Yes ] Net Monthly Income:$
Account Type (Circle applicable response) : [ No]
Proof of Income: [ 2 Pay slips ]
[Job Letter]
Total Expenses:$
Additional Income:$
[Checking ]
[ 2 Months Bank Statement ]
[ Savings ]
Disposable Income:$
Source of Additional Income
EXPENSES Electricity: $
Water: $
Telephone:$
Cable: $
Rent/Mortgage: $
Other: $
Credit Card: $
Food: $
Loans: $ 1
[Other]
[ Record/Receipt Book ]