Melbond

MELBOND
SALARY LOAN APPLICATION FORM Contact: 0302-937814 /16/17

1. PERSONAL DETAILS Residential Address; __________________________________

Mr./Mrs./Miss./Dr./Prof Surname: _________________ Phone Numbers: _____________________________________

Other Names: __________________________________ 4. Employment details

Employer’s Name & Address

Date of Birth: _____________Place of Birth: __________
_____________________________
Nationality: _____________ Sex Male Female
____________________________________________________
_
ID Type and Number (attach copy) _________________
Tel no. _______________ Physical Location ________________
No. of Dependants ___________
No. of years with employer (years & months) ______________
Marital status: single married Divorced
separated Net salary per month (Attach copy of pay slip) ______________

Postal Address: _______________________________________ Contract type permanent Temporary

2. RESIDENTIAL DETIALS Expiry Date ________________ Job Title _________________

Residential Address: Staff No. __________________ AG’s code ________________

____________________________________
5. BANKING ACCOUNT DETIALS
Street Name:
__________________________________________ Name(s) 0f bank(s) where your account is held

Residential status Owner Tenant Employer ___________________________________________________

Family mortgaged provided Branch(s) ___________________________________________

Telephone Nos: Work_______________ Mobile____________ Account(s) held Current savings other

E-Mail: _____________________________________________ Current account no. ______________________

3. SPOUSE RELATIVES’ DETAILS Savings account no. ______________________

Spouse’s Have you previously taken an item from the company? _____
Name________________________________________
What was the cost of the item? _________________________
Tel _________________________
When was the last installment paid? ______________________
Spouse’s Employer’s Name & Address
Have you taken a loan from a financial institution before? Yes
____________________________________________________
No
____________________________________________________
____________________________________________________ If yes from what institution was the loan taken?
___
_______________________________________
Names and Address of Guarantor(s)
Amount of loan ______________ Date repaid ______________
Full Name: __________________________________________
Where a loan is outstanding, please state:
Postal Address: ______________________________________
Repayment terms: _______________________________
 Melbond

MELBOND
SALARY LOAN APPLICATION FORM Contact: 0302-937814 /16/17

Amount outstanding: _____________________________ 9. EMPLOYER’S CONFIRMATION

We confirm that above is an employee of this organization

and confirm that we shall act in consonance with the written
6.
instruction above. In addition, we shall notify you in seven (7)
LOAN APPLICATION DETAILS
working days should this employee’s service be terminated by
this organization for any reason or should the employee
Purpose:
resign from his employment. Accrued terminal benefits are to
___________________________________________________
be paid to the company should either part terminate
Loan Amount (GH¢) ___________________________________ appointment prematurely for the duration of the facility.

Tenure (months) ______________________________________ Name of Organization

_________________________________
Repayment method: Cheques Standing Order
Authorized Signature (Name & Position)
Deductions by A/c Gen Monthly deduction by employer __________________________________________________

7. AUTHORITY TO EMPLOYER ______________________________Date: ___________

I have consented as follows: 10. OFFICIAL USE ONLY (MKT EXECUTIVE)

Please deduct loan installments of ______________from my Marketing Executive’s code

salary and remit these on monthly bases to MELBOND in __________________________________________________
reduction of my short-term loan facility with the company until
further notice. This directive may not be varied unless this is Loan Amount GH¢ _______________________________
expressed in writing jointly from me and the company.
Interest _________fees _______ _
Applicant signature Date
total amount ___________
_______________ _______________
Tenure (months) _________Monthly repayments__________
8. CUSTOMER DECLARATION
Net salary _____________________________
I hereby certify that the information contained in this
Recommended Mkt Executive ___________
application is correct and that it provides a full and complete
picture of my financial position. You are hereby authorized to Not Recommended Mkt Executive ___________
obtain any confirmation you may require about the details
provided from my employers and/or bankers in other to 11. OFFICIAL USE ONLY – CREDIT RISK MGT
consider this application. I also confirm that details on my
credit/loan status may be availed to an approved credit bureau Date Received ______________Interest rate _____________
subscribed to by the company. As an integral part of this
Monthly repayments _____________ Expiry date _________
application, I consent to credit life insurance cover being
arranged to cover the facility. I understand and accept that the Checklist reviewed ________conforms with credit policy ____
insurance policy may not cover all forms of disability or death.
Notwithstanding the insurance cover, I understand and agree Approved/Declined Authorized approver & Date
that I am personally liable to MELBOND for the credit facility,
_______________ ________________________
interest, insurance, premiums, charges, fees and/or penalties. I
also confirm that I have read and understood and agreed to be
bound by the terms and conditions of the facility.

Applicant’s Signature Date

__________________ _______________