PLEASE FILL OUT FORM CLEARLY IN TYPE OR PRI Requirement: Please attach the following when submitting your ion TWO VALD GOVERNMENT-ISSUED PHOTO ios (equortugesimdeguttyIM PROOF OF ADDRESS not older than 3 manths (e.g. Utilty ar Cable Bill, Account Statement) PROOF OF INCOME no older than 3 months (ob Letter with last Engociol Records if I hereby apply for a LOAN LINE OF CREDIT months/years. I can/wish to 1in the amount of $ repay S- for a period of PURPOSE of loan: ALREADY A MEMSER A/C NO. 1 YES MY PERSONAL INFORMATION CITIZENS TIME IN PASSPORT If appicabiel TELEPHONEHOME PHYSICAL ADOAESS E MAIL ADDRESS MARITAL STATUS (kk one) SNGLE MARREO SEPARATED NAME OF SPOUSE NO, OF DEPENDENTS MY INCOME INFORMATION Total/Mth Salary/Wages Other (State) TOTAL MY ASSETS (What do you own?) Type MY NORMAL MONTHLY EXPENSES Estimated Value (S) Cable Cellular Phone Child Church Tithe at SICCU Land Life Insurance Motor Vehicle Other p Total MY LIABILITIES (What do you owe?) Estimated Monthly Type Credit Card [ at Mortgage (at Loan lat Loan (at Hire Purchase Money lender is Other dat Total In signing this application form, I hereby certify the abave information to be true and complete. Further, I authorize and give consent to Credit Credit Card Payment Electricity (Utility) Gym Health insurance Hire purchase payments House insurance Life insurance Loan payments Personal care Property tax INTEREST RATE TERM CASH DEPOSIT COLLATERAL IType & Value) ONE MONTH'S INSTALLMENT MONTHLY PAYMENT PAYMENT BREAKDOWN %[S nsurance Savings Property Ta PROCESSING FEE STAMP DUTY PAYMENT METHOD ACCOUNT BALANCES MS VS SAVINGS INS LN 1 LN2 PROPOSED LOAN BREAKDOWN Purpose Payable to Amount TOTAL LOANS OFFICER RECOMMENDATION Not Recommended COMMENT PROCESSED BY: MEMBER CONTACTED: APPT FOR USE OF THE CREDIT SUPERVISOR/MANAGEMENT I 1 Eligible ineligible Other bate Comments Describe what information is gatheref and analyzed, categorizing these bases on the principles of credit Are there any deficiency in infornation gathering and analyzing areas