Passport
Photograph
CITICORP FINANCIAL SERVICES LIMITED
LOAN APPLICATION FORM
PERSONAL DATA:
DATE APPLIED:………………….
SURNAME:……………………………………………………………………………………………….
OTHER NAMES: …………………………………………………………………………………………
DATE OF BIRTH: …………………………………………………………………………………………
AGE: ……………………………………………………………………………………………………….
MARITAL STATUS: ………………………………………………………………………………………
NO. OF CHILDREN: ……………………………………………………………………………………….
WEDDING ANNIVERSARY: ……………………………………………………………………………..
RESIDENTIAL STATUS:
PRESENT:
PERMANENT:
HOME ADDRESS:……………………………
HOME ADDRESS:………………………..
………………………………………………….
………………………………………………
TEL. NO:……………………………………….
TEL. NO:…………………………………...
E-MAIL ADDRESS: …………………………..
E-MAIL ADDRESS:……………………….
EMPLOYMENT STATUS:
NAME OF THE COMPANY: …………………….
NEXT OF KIN:
………………………………………………………
NAME: ……………………………………..
NATURE OF BUSINESS: …………………………
ADDRESS: ………………………………...
ADDRESS: …………………………………………
DATE OF BIRTH ………………………….
TEL. NO: ……………………………………………
TEL. NO: …………………………………..
PRESENTGRADE:
…………………………………………………………………………….….……………………………….
LENGTH OF SERVICE: …………………………………………………….……………………………….
PREVIOUS EMPLOYER: ……………………………………………………………………………………
………………………………………………………………………………………..………………………..
REASON FOR LEAVING: ……………………………………………………………..…………………….
…………………………………………………………………………………………………………………
Can we confirm the fact stated above:? …………………………………………………………………..
Will you inform CITICORP of any change in your Residential or Employment address?
YES
NO
INCOME STATUS
MONTHLY INCOME
MONTHLY EXPENDITURE
Basic Salary:…………………………………………
Rent:……………………………………….
Allowance: …………………………………………..
House Allowance:…………………………..
Mandatory Deductions: ………………………………
School Fees: ………………………………..
Others: ………………………………………………...
Insurance:…………………………………...
Dividend: ………………………………………………
Running Cost: ……………………………...
Miscellaneous: …………………………………………
Miscellaneous: ……………………………..
CREDIT HISTORY
Have you ever borrow from Citicorp? (Pls tick)
YES
NO
When………………………………………………………
Amount: …………………………………………………..
Outstanding Balance: ……………………………………..
OTHER OUTSTANDING LOAN FACILITIES
NAME OF BANK/ORGANIZATION:……………………………………………………………………….
ADDRESS: ……………………………………………………………………………………………………
AMOUNT: …………………………………………………………………………………………………….
COLLATERAL: ………………………………………………………………………………………………
REPAYMENT STRUCTURE: ……………………………………………………………………………….
NAME OF BANK/ORGANIZATION:……………………………………………………………………….
ADDRESS: ……………………………………………………………………………………………………
AMOUNT: …………………………………………………………………………………………………….
COLLATERAL: ………………………………………………………………………………………………
REPAYMENT STRUCTURE: ……………………………………………………………………………….
OTHER LOANS e.g Office/Personal:
AMOUNT: …………………………………………………………….………………………………………
MONTHLY REPAYMENT: …………………………………………………..………………………….
LOAN FACILITY REQUIRED
ASSET:………………………………………………………………………………..…………………….
ASSET COST: ………………………………..…………………………………………………………….
FACILITY AMOUNT:………………………………………………………………………………………
PURPOSE: …………………………………………………………………………………………………
DURATION: ……………………………………………………………………………………………….
SOURCE OF REPAYMENT: ……………………………………………………………………………...
SECURITY PROPOSED/OFFERED:……………………………………………………………………...
Are you willing to meet up your commitments in line with the provisions of the Citicorp Loan?…………...
Do you have a life insurance policy that is currently valid? ……………………….
DECLARATION
I ………………………………………….. hereby confirm that the information provided here is correct to
the best of my knowledge and intent. I also authorised Citicorp Financial Services Limited to make
enquiries considered necessary in establishing opinion on this lease. I also confirm that the granting of this
loan is not automatic but subject to a satisfactory opinion of Citicorp Financial Services Limited.
DATE: ……………………………………
SIGNATURE: ……………………………………..
GUARANTEE
EMPLOYER
NAME OF EMPLOYER:…………………………………………………………………………………..
ADDRESS:……………………………………………………………………………………………………
…………………………………………………………………………………………………………………
Are you willing to guarantee this loan transaction to the employee?
YES………………… No…………..(Pls indicate)
Will you ensure that the outstanding balance on his/her account is paid even if the applicant leaves the
employment? Yes……….... No……….(Pls indicate)
In the event of default, will you make good his account and remit to us?
No…………………………..(Pls indicate)
Yes…………….
NAME OF THE OFFICIAL…………………………………………………………………………………
SIGNATURE………………………………………………………………….……………………………..
STAMP /SEAL………………………………………………………………..……………………………...
OTHER GUARANTOR
NAME OF THE GUARANTOR…………………………………………………………………………….
OCCUPATION………………………………………………………………………………………………
ADDRESS……………………………………………………………………………………………………
TELEPHONE NO…………………………………………………………………………………………..
Are you willing to guarantee this loan transaction to the employee? Yes……….…No……… (Pls indicate)
Will you be paying on behalf of this applicant? Yes …….……..
Signature………………………….…………
No………………… (Pls indicate
Date……………………………………………….
IN THE PRESENCE OF:
NAME……………………….…………………………………………………………………………………
ADDRESS………………………………………………………………….………………………………….
SIGNATURE…………………………………………………………………………..………………………
REQUIREMENTS
o
Copy of driver’s license/passport
o
A copy of employer’s ID card
o
Employer’s letter of undertaking
o
Letter of employment
o
Letter of confirmation
o
Payslip for the past three (3) months
o
Marriage/Birth Certificate
o
Tenancy Agreement (where utility bill is not in applicant name)
o
Utility bills
o
Statement of Account for the past six (6) months