Secured & Debt Consolidation Loan Form

Date of Loan:

Loan Code:

Loan Type

Loan Ref:

SECTION A - MEMBER INFORMATION

Account Number:

Member Name:

Marital Status:

Home Address:

Own/ Rent/ Other:

Date of Membership:

Gender:

# of Dependents:

Mailing Address:

Contact Number:

TRN: (Mandatory)

Date of Birth:

Age of Dependents:

Period of Residency:

Email Address:

SECTION B - EMPLOYMENT INFORMATION

Name of Employer:

Address of Employer:

Occupation/ Title:

Employment Status:

Occupation/ Title:

Employer Telephone Number:

SECTION C - SPOUSE INFORMATION

Name of Spouse:

Spouse Address:

Spouse Contact #:

Spouse TRN:

Spouse Employer:

Spouse Employer Address:

Spouse Occupation/ Title:

SECTION D - NEAREST RELATIVE INFORMATION (Not living with you)

Name of Nearest Relative:

Address:

Relation:

Contact Number:

SECTION E – REFERENCE (Mandatory)

Name of Reference:

Reference Address:

Reference Contact #:

Period Known:

SECTION F - LOAN DETAILS

Loan Amount/ Borrowed:

Repayment Terms:

Interest Rate:

Purpose:

Debt Ratio (%)

Credit Score:

SECTION G -SECURITY/COLLATERAL INFORMATION

Security Offered:

Market Value:

Forced Sale Value:

Registered Value:

Security Offered:

Market Value:

Forced Sale Value:

Registered Value:

Security Offered:

Market Value:

Forced Sale Value:

Registered Value:

SECTION H - ASSETS

Assets Owned:

Value of Assets Owned:

Description of Assets Owned:

Assets Owned:

Value of Assets Owned:

Description of Assets Owned:

Assets Owned:

Value of Assets Owned:

Description of Assets Owned:

Total Net Worth:

SECTION I- LIABILITIES

Name of External Creditor:

Purpose:

Monthly Payment:

Name of External Creditor:

Purpose:

Monthly Payment:

Name of External Creditor:

Purpose:

Monthly Payment:

Name of External Creditor:

Purpose:

Monthly Payment:

SECTION J- INCOME & EXPENDITURE

Total Gross Income:

Other Income:

Statutory Deduction:

Net Income:

SECTION K- INCOME & EXPENDITURE

Debt Payments:

Monthly Contributions:

Living Expenses:

Monthly Contributions:

Total Expenses:

Net Surplus:

Borrowing Capacity:

Debt Service Ratio:

SECTION L -SHARES & DEPOSITS

Share Equity Balance:

Permanent Share Balance:

Ordinary Shares Balance

Deposit Balance:

SECTION M- DEDUCTIONS

Loan Type:

Monthly Deduction:

Share/ Saving Type:

Monthly Deduction:

PROCESSING FEES

Refinance Fee:

Service Charge:

BOS/ Registration Fee:

Credit Bureau Fee:

GCT:

Total: