CUSTOMER INFORMATION FILE DATA SHEET
The NHT is developing a database of its contributors in order to better serve them. If you are a contributor, you can help by completing this form
1a. Full Name
*
First Name
Middle Name
Last Name
1b. Other name(s) (Maiden etc.)
1c. How was your name changed? By Marriage. Deed Poll When
2. Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
3a. Parish of birth
3b. Country of birth
4a. NIS number
Please include preceding letter
4b. Other NIS number(s)
5. TRN number
6. What is your present occupation?
7. Mailing address(where you collect you mail)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
8. Have you ever received a mortgage loan from the NHT?
Yes
No
9a. Kindly give the name(s) of your present and past employers
Rows
Name of the company or branch
Period (from/to)
Company's ref#
1
2
3
4
5
6
9b. Self Employed
Rows
Period (from/to)
1
2
9c. Voluntary Contributor
Rows
Period (from/to)
1
2
Current Weekly Income (Gross)
*
How can we contact you?
10. Telephone Number
(H)
(W)
Extension#
11. Fax Number
(H)
(W)
12. E-mail
example@example.com
13. Number of Bedrooms Occupied
14. Number of Dependents
15. Tenure Status
Lease
Ownsproperty
Live Rent Free
Rent
16. Best time for contact
17a. Contact person
17b. Telephone Number
Submit
Should be Empty: