Home Improvement Loan Application – Maximum $15,000.

00

Main Applicant • Personal Information

□ Mr. □ Mrs. □ Ms. □ Miss □ Other_______

___________________________________________________ _____________________________________________ ____________
Last Name First Name Middle Initials

__________________________________________________________________________________________________________________
Residential Address Parish Postal Code Years at Present Address

__________________________________________________________________________________________________________________
Mailing Address (if different from above) Parish Postal Code Years at Pervious Address

_______________________________ _____________________
Residence: □ Rent □ Own □ Own Free and Clear □ Live with Relatives Name of Landlord or Mortgage Holder Telephone No.

(______)_________-______________ (______)_________-______________ (______)_________-______________

Home Telephone Work Telephone Cell Number

__________________________________________________________________________________________________________________
Email Address

__________________________________________________________________________________________________________________
Date of Birth (DD/MM/YYYY) ID Type ID Number

□ Married □ Single □ Separated □ Divorced □ Widowed No. of Dependents_______ Ages____________________

Bermudian: □ Yes □ No If No, Nationality______________________ Date moved to Bermuda (DD/ MM/ YYYY)________________

__________________________________________________________________________________________________________________
Name of Present Employer Occupation Start Date (DD/MM/ YYYY)

__________________________________________________________________________________________________________________
Name of Previous Employer Occupation Years of Employment

__________________________________________________________________________ ______________________________________
Name of Contact (not currently residing with you) Telephone No.

Do you have any outstanding debts with Bermuda Credit Association? □Yes □No
Do you have any outstanding judgements or are you a defendant in any suits or legal actions? □Yes □No
Do you have any obligations as an endorser, co-maker or guarantor? □Yes □No

Private and Confidential

Home Improvement Loan Application – Maximum $15,000.00

Joint Applicant • Personal Information

□ Mr. □ Mrs. □ Ms. □ Miss □ Other_______

___________________________________________________ _____________________________________________ ____________
Last Name First Name Middle Initials

__________________________________________________________________________________________________________________
Residential Address Parish Postal Code Years at Present Address

__________________________________________________________________________________________________________________
Mailing Address (if different from above) Parish Postal Code Years at Pervious Address

_______________________________ _____________________
Residence: □ Rent □ Own □ Own Free and Clear □ Live with Relatives Name of Landlord or Mortgage Holder Telephone No.

(______)_________-______________ (______)_________-______________ (______)_________-______________

Home Telephone Work Telephone Cell Number

__________________________________________________________________________________________________________________
Email Address

__________________________________________________________________________________________________________________
Date of Birth (DD/MM/YYYY) ID Type ID Number

□ Married □ Single □ Separated □ Divorced □ Widowed No. of Dependents_______ Ages____________________

Bermudian: □ Yes □ No If No, Nationality______________________ Date moved to Bermuda (DD/ MM/ YYYY)________________

__________________________________________________________________________________________________________________
Name of Present Employer Occupation Start Date (DD/MM/ YYYY)

__________________________________________________________________________________________________________________
Name of Previous Employer Occupation Years of Employment

__________________________________________________________________________ ______________________________________
Name of Contact (not currently residing with you) Telephone No.

Do you have any outstanding debts with Bermuda Credit Association? □Yes □No
Do you have any outstanding judgements or are you a defendant in any suits or legal actions? □Yes □No
Do you have any obligations as an endorser, co-maker or guarantor? □Yes □No

I/We hereby declare that the information which I/ We have provided to you in support of this application is true and complete in all material respects and that no
information is omitted in relation to any of the items describing my/our liabilities. I/ We authorize you to contact such persons as you think fit to verify the
correctness and completeness of this information and authorize any such persons to release it to you.

Signature of Main Applicant__________________________________ Signature of Joint Applicant_________________________________________________

Date (DD/MM/YYYY)________________________________________ Date (DD/MM/YYYY)______________________________________________________

Private and Confidential

Home Improvement Loan Application – Maximum $15,000.00

Income Statement Statement of Net Worth

Monthly Income Current Assets (what I own)
Applicant's Salary (net) Chequing and Savings Accounts: Balance:
Co-Applicant's Salary (net) #____________________
Child Maintenance #____________________
Investment Income #____________________
Rental Income Term Deposits
Other Income__________________ Investments
Bonus________________________ Stocks/Mutual Funds
Pension (provide statements)
Total Monthly Income $
What I'm Owed_______________
Monthly Commitments Other_______________________
Mortgage ____________________________
Rent Total Current Assets $
Church Tithes
Child Maintenance Payment Fixed Assets
Installment Payments / Loans: Home I Fair Market Value
Vehicle
Real Estate: □ Local
Furniture
Personal Loans □ Overseas
Credit Cards – 10% of Limit Vehicle
Other Monthly Obligations Household Effects
Land Tax Other________________________
Home Total Fixed Assets $
Insurance Total Assets $
Life Insurance Liabilities (What I Owe)
Miscellaneous Mortgage(s) (Disclose Bank): Balance:
Total Monthly Expenditures $ _____________________________
_____________________________
Personal Loans (Disclose Bank):
I/We hereby declare that the information provided herein is _____________________________
true and complete in all material respects and that no _____________________________
information is omitted in relation to any of the items _____________________________
describing my/our income and expenses. Credit Cards (Authorized Limit):
Clarien Bank Limited
HSBC
BNTB
_________________________________________________________
Other
Signature or Main Applicant Date(DD/MM/YYYY) _____________________________
Other Debt:
_____________________________
_____________________________
___________________________________________________ _____________________________
Signature of Joint Applicant Date(DD/MM/YYYY) Total Liabilities $
Net Worth $

Private and Confidential

Home Improvement Loan Application – Maximum $15,000.00

Proposed Repairs and/or Modifications

Location of Property:

____________________________________________________________________________________________________________________________
Address Parish Postal Code

Description of Repairs/Modifications:

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

Estimated cost:

$___________________

Contractor Name if applicable:

____________________________________________________________________________________________________________________________
Name

____________________________________________________________________________________________________________________________
Address Parish Postal Code

(______)_________-_________________ (______)_________-_________________ __________________________________

Business Telephone Cellular Number Email Address

Please provide any other supporting documentation.

I/We hereby declare that the information which I/ We have provided to you in support of this application is true and complete in all material respects and that no
information is omitted in relation to any of the items describing my/our liabilities. I/ We authorize you to contact such persons as you think fit to verify the
correctness and completeness of this information and authorize any such persons to release it to you.

Signature of Main Applicant_________________________________________ Signature of Contractor_________________________________________________

Date (DD/MM/YYYY)_______________________________________________ Date (DD/MM/YYYY)___________________________________________________

Private and Confidential