HALIFAX FINANCIAL LOANS
Pembridge House, 5 Bird Street, Eastern Cape, Port Elizabeth
Postal Address: P. O. Box 1282, Port Elizabeth Postal Code: 6000
Email: hfl1@live.co.uk Website: www.halifax.co.uk
Tell:+27846978097
LOAN APPLICATION FORM
(APPLICANT MUST FILL COMPLETELY IN BLOCK LETTER)
Last Name:_______________________________________________________________
First Name: __________________________Middle Name_________________________
Full Residential Address:____________________________________________________
Full Postal Address:________________________________________________________
Home/Office Tel: ___________________Cell Phone:_____________________________
Email Address:____________________________________________________________
Marital Status:________________________Sex/Age:_____________________________
Monthly Income:__________________________________________________________
Type Of Loan:_____________________________________________________________
Amount Needed:__________________________________________________________
Loan Duration In Years:_____________________________________________________
Purpose of Loan (Give Details):_______________________________________________
________________________________________________________________________
Are You A Property Owner? Yes ( ) No ( ) If yes give details_______________________
Do You Have an Existing Debt: Yes ( ) No ( ) If yes give details______________________ I
hereby certify that the above information is true and to the best of my knowledge.
_________________________
____________________
Applicant’s Signature
Date