Form 11102 CAY (06/2011)
PERSONAL LOAN APPLICATION OR
STATEMENT OF AFFAIRS
This application is the property of RBC Royal Bank (Cayman) Limited
BRANCH:
ACCT. OFFICER CODE:
AMT OF LOAN REQ.:
PURPOSE OF LOAN:
NEG FEES:
DATE (YYYY/MM/DD):
VISA ACCT NO.:
CUSTOMER MASTER NO.:
NATIONAL INSURANCE NO./NATIONAL I.D.:
MASTERCARD ACCT NO.:
DRIVER’S LICENSE NO.:
EXPIRY DATE (YYYY/MM/DD):
PASSPORT NO.:
EXPIRY DATE (YYYY/MM/DD):
PERSONAL INFORMATION
NAME (PLEASE PRINT)
DATE OF BIRTH (YYYY/MM/DD)
HOME ADDRESS – NUMBER, STREET, CITY
NAME & ADDRESS OF LANDLORD (IF RENTING)
TELEPHONE NUMBERS
Home:
Work:
PREVIOUS ADDRESS
NAME OF PERSONAL REFERENCE – IMMEDIATE FAMILY PREFERRED
ADDRESS – STREET, CITY, P.O. BOX
NAME OF PERSONAL REFERENCE – IMMEDIATE FAMILY PREFERRED
ADDRESS – STREET, CITY, P.O. BOX
NAME OF BANK OR FINANCIAL INSTITUTION
HAVE YOU ANY JUDGEMENTS OR
LEGAL PROCEEDINGS AGAINST YOU?
HAVE YOU EVER BORROWED
BEFORE FROM ANY SOURCE?
AMOUNT
YES
POSTAL BOX
AGE
SINCE (YEAR)
IF YES, WHERE AND WHEN
NO
NO. OF DEPENDENTS
(INCL SPOUSE)
DATE OF BIRTH
(YYYY/MM/DD)
SPOUSE’S NAME
Cell:
YEARS THERE
YES
NO
TELEPHONE NUMBERS
RELATIONSHIP
Home:
Cell:
Work:
TELEPHONE NUMBERS
RELATIONSHIP
Home:
Cell:
Work:
IF YES, SEE PAGE 2
INDIRECT LIABILITIES (GUARANTEES
YES
OR ENDORSEMENTS FOR OTHERS)
FOR DETAILS
NO
!
"
HAVE YOU HAD ANY PREVIOUS LOANS
FROM THE ROYAL BANK?
YES
MARTIAL STATUS
IF YES, WHERE AND WHEN
AMOUNT
NO
EMPLOYMENT INFORMATION
NAME & ADDRESS OF EMPLOYER
TELEPHONE
OCCUPATION
POSITION
EMPLOYMENT DATE
(YYYY/MM/DD)
EMPLOYEE NO.
RENT:
PREVIOUS EMPLOYER
EMPLOYMENT DATE
(YYYY/MM/DD)
NAME & ADDRESS OF SPOUSE’S EMPLOYER
OCCUPATION
PRESENT ANNUAL SALARY OR WAGES
TELEPHONE
POSITION
50%
OTHER
INCOME
75%
(SOURCE)
EMPLOYMENT DATE
(YYYY/MM/DD)
SPOUSE’S ANNUAL SALARY OR WAGES
EMPLOYEE NO.
PREVIOUS EMPLOYER
EMPLOYMENT DATE
(YYYY/MM/DD)
TOTAL ANNUAL INCOME
$ 0.00
!
$ 0.00
TOTAL MONTHLY INCOME
FINANCIAL INFORMATION
ASSET
AMOUNT
LIABILITIES
AMOUNT
MONTHLY PMT
(LOANS, MORTGAGES, CREDIT CARDS. ALL OTHER DEBTS)
CASH (ROYAL BANK)
MORTGAGE
CASH (OTHER)
LIQUID INVESTMENTS (STOCKS, BONDS, ETC.)
RENEWAL DATE (YYYY/MM/DD)
BANK LOANS – ROYAL
BANK LOANS – OTHER
LOANS – CREDIT UNION
LIFE INSURANCE –
FACE AMOUNT
PAYABLE TO
csv
OTHER LIQUID ASSETS (SPECIFY)
LOANS – INSURANCE CO.
CREDIT CARDS – VISA ROYAL – LIMIT $
CREDIT CARDS – OTHER – LIMIT $
REAL ESTATE
OTHER DEBTS (SPECIFY)
AUTOMOBILE
YEAR AND MAKE
YEAR AND MAKE
FURNITURE
OTHER
MONTHLY RENT (IF APPLICABLE)
OTHER
SUBTOTAL
OTHER
SURPLUS
TOTAL
!
REAL ESTATE OWNED - LOCATION
APPLICABLE LOAN TYPE
INTEREST RATE VALID UNTIL
/
$ 0.00
REGISTERED - OWNER
/
TOTAL
YR PURCHASED
ROYAL BANK PRIME PLUS
%
ROYAL BANK PERSONAL LOAN BASE RATE PLUS
FIXED
%
PURCHASE PRICE
%
PAYMENT
!
$ 0.00
$ 0.00
$ 0.00
$ 0.00
VALUE
TERM
EQUITY
FIRE INS
AMORTIZATION
Page 1 of 2
Form 11102 CAY (06/2011)
I/We warrant and confirm the information given herein is true and correct and I/We understand it is being used to determine My/Our
credit responsibility. I/We further confirm that no information, which might affect the Bank's decision to make the loan, has been
withheld. I/We hereby authorize and consent to the Bank receiving and exchanging any financial and other information which it may
have in it's possession about Me/Us with any of it's subsidiaries, agents, third party assignees, other financial institutions, Credit
Bureaus or other person of Corporation or with whom I/We may have or propose to have financial dealings from time to time. I/We
indemnify the Bank against any loss, claims, damages, liabilities, actions and proceedings, legal and or other expense which may be
directly and reasonably incurred as a consequence of the disclosure of the financial information. My/Our deposit account may be
charged with the monthly payments as they mature and I/We agree to pay your customary assessment for any notices of overdue
installments.
PAYMENT IN MONTHLY INSTALLMENTS
APPLICANT’S SIGNATURE
BEGINNING ONE MONTH FROM DATE OF NOTE / AGREEMENT
/
BEGINNING -
MATURITY DATE -
/
/
/
CO-SIGNOR (SPOUSE ONLY)
SOURCE OF BUSINESS
NEW
MAIL DROP
REFINANCE
DIRECT MAIL
FORMER
WALK IN
NEWSPAPER
SIGN
RADIO
STAFF REFERRAL
TV
CLIENT REFERRAL
OTHER (SPECIFY)
JUDGEMENTS OR LEGAL PROCEEDINGS (PARTICULARS)
INDIRECT LIABILITIES (PARTICULARS)
INVESTIGATION
EMPLOYER CONFIRMS
POSITION
SALARY VERIFICATION/CONFIRMATION DETAILS:
INCOME
SERVICE
PREVIOUS EMPLOYER CONFIRMS
POSITION
INCOME
SERVICE
SPOUSE’S EMPLOYER CONFIRMS
POSITION
INCOME
SERVICE
LANDLORD / MORTGAGE HOLDER
MO. PAYMENT
YEARS THERE
LIFE INSURANCE
PAYING HABITS –
GOOD /
SLOW
APPRAISAL
EXISTING CREDITORS (Verify standing of account with all creditors.)
NAME OF COMPANY / BANK
TELEPHONE
DATE ACCT OPENED
/
/
/
/
HIGH CREDIT
TERMS
BALANCE
RATING
OTHER INFORMATION OBTAINED
RECORD PARTICULARS OF LAST CHECK COMPLETED
CONFIRMATION
GENERAL INFORMATION
YES
NO
DATE ACCT
OPENED
REFERENCE CHECKED
AGE
ADDRESS
EMPLOYER
SALARY
/
/
/
/
/
/
/
/
HIGH CREDIT
PRESENT
BALANCE
TERMS
INVESTIGATOR’S REMARKS
NO. OF YEARS
RBC CUSTOMER
COLLATERAL SECURITY
HELD
TO BE OBTAINED
RATING
INITIALS
BEING SENT
SHOW FULL PARTICULARS FORM NO. AND
DESCRIPTION OF SECURITY.
}
ENDORSEMENT(S) AND/OR CO-SIGNER(S) (ATTACHED S.O.A.)
INSERT NAME(S) AND THE DEGREE
OF PROTECTION AFFORDED SUCH
AS NET WORTH, ETC.
}
TOTAL DEBT SERVICE RATIO
(SPOUSE MUST CO-SIGN IF INCOME BEING USED)
INFORMATION CHECK LIST
REFINANCE
LOAN #
CREDIT A/C #
TOTAL MONTHLY PAYMENTS INCLUDING NEW LOAN
GROSS MONTHLY INCOME
X 100 =
% (should not exceed 40%)
AUTOMOBILE INSURANCE VERIFIED
REGISTERED CHATTEL MORTGAGE
SALARY ASSIGNMENT
CHATTEL MORTGAGE ON MOTOR VEHICLE TAKEN /
BILL OF SALE ON MOTOR VEHICLE TAKEN
SPOUSE’S COVENANT HELD
SALARY DEDUCTION -
TRANSIT #:
LOAN NOTE DATE -
/
/
TRANSIT #:
LOAN #
TRANSIT #:
DEBIT A/C #
TRANSIT #:
CREDIT BUREAU RESULTS:
APPROVING
OFFICER
CREDIT POLICY EXCEPTIONS
®
NAME AND SIGNATURE
Registered trademark of Royal Bank of Canada. RBC Royal Bank of Canada is a registered trademark of Royal Bank of Canada.
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