Loan Application Form

Is this your first loan application/first time client with Barateng?

Have you changed your employer/job within the last six months or since your last loan with us?

Have you changed your contact details or address within the last six months or since your last loan with us?

Title:

Full Name

First NameLast Name

Birth Date

MonthDayYear

Gender

Race

Marital Status:

Email address

Nationality

Passport/ID number

Next of Kin Full Name ( if married it must be your spouse if not married it must be the next of kin person who we can contact)

Next of Kin Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Number of dependents

Phone

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have you lived in your given address?

Are you under debt review?

Present Employer

Occupation

Years with employer/ Working Experience

Loan product type

Pay Date/ Debit order date

Gross monthly income

Net Monthly Income

Loan Request Amount

Collateral Description

Do you own an Asset/Approved Purchase Order that you can put down as collateral against the Loan Request?... please write description and send proof of collateral in the form of picture, proof of purchase, scanned documents of business purchase orders or payslips. This improves your chances for approval. By listing this item on the loan request you agree that the collateral can be collected and claimed by Barateng Cash Loans in the event that you fail to pay as per agreement.

Account Details to deposit the loan amount into. Please mention Bank Name, Savings/Check Account, Acc Number and Branch number

General Comments and reasons for loan:

I authorize Barateng Cash Loans and it's partners to obtain personal and credit information about me from my referees, my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. This information, as well as that provided by me in the application, will be referred to in connection with this lease and any other relationships we may establish from time to time. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus or other credit reporting agencies. *

I authorize Barateng Cash Loans and it's partners to claim the listed collateral items in the event I fail to settle the agreed loaned amount. I certify and declare that I have permission and authority to liquidate the item listed as collateral. I agree that the collateral item can be collected and claimed by Barateng Cash Loans in the event that you fail to pay as per agreement.

I hereby agree that the information given is true, accurate and complete as of the date of this application submission. *

Signature

How did you find out about us?

Referee Full name (the name of the person who referred you to us, please note this person must be one of our staff/agents or previous or current clients - you have better chances of loan approval if you are referred by a previous/current client/someone we know)

Optional

Referee Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Loan Application Form

Contact Information

Employment Information