Loan Application Form

Loan Application Form
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YesNo
YesNo
Contact Information
Title:*
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
MaleFemaleOther
Race*
SingleMarriedOther
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
0-1 Year1-2 Years3-4 Years5+ Years
YesNo
Employment Information
Present Employer*
Occupation*
0-1 Year1-2 Years3-4 Years5+ Years
Borrow against collateral asset/Item of approximate liquid value of loanPayDay Loan - Payback on your payday upto 30days - fixed 30% interest and fees charges)installment Agreement Loan - (pay within 6 months to 12 Months, you pay according to pàyback capacity, we don't have a fixed interest here we agree on the number of instalments, collateral, ceiling amount payable and ceiling term)
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. **

YES
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Signature*

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FacebookReferred by one of our clientsInternet searchWord of MouthSaw an AdvertisementOther
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.
Should be Empty:

Loan Application Form

Contact Information

Employment Information