LOAN APPLICATION FORM

(FOR OFFICE USE ONLY)
Ref No.

New LoanRe-Loan
Ref No.
LOAN DETAILS
Where did you hear about us?
Did someone help you for it? If yes, who?
Amount Requested

Payment Frequency: Bi-weekly / Monthly / Semi-Monthly / Other:Other
Amount Requested
First Repayment Date

MonthDayYear
Date
Loan Term
Months
Payment Frequency: Bi-weekly / Monthly / Semi-Monthly / Other:

Loan purpose: Flight Ticket / Sending to Family/ Debt Consolidation / Car Purchase / Living Expense / Tuition/ Travel / Family(in Canada) / Other(Please specify):
/ Other(Please specify)
GUARANTOR/S
Name of Guarantor 1
How Long You know Guarantor 1:
Relationship
Name of Guarantor 2
How Long You know Guarantor 2:
Relationship
Name of Guarantor 3
How Long You know Guarantor 3
Relationship
PERSONAL INFORMATION
Name

First NameMiddle NameLast Name
Date of Birh(DD/MM/YYYY)

MonthDayYear
Date
Marital Status: Single / Separated / Married or Domestic Partner
Marital Status
Name of Spouse
Number of dependents
3rd

Age of dependents: 1st
Years in Canada
Residency Status: Canadian Citizen / Permanent Resident / Work Permit / Others:
Residency Status
Permanent Resident
CONTACT DETAILS
Cell No.
Home No.
E mail(Print)
example@example.com
Home Owner / Living with others / Rent / Boarding / Others:
Housing Status
Monthly Rent/Board/Mortgage
Time at current address: Years
Years
Months
Address

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Province
Postal Code
(If less than 6 months) Previous address
City
Province
Postal Code
Owned / Rented
Monthly payment or rent
Years
Months
EMPLOYMENT INFORMATION
Employment State: Full time / Part time / Self-employed / Contract / Unemployed / Sick Leave / Retired
Name of Current Employer
Your occupation
Address

Employer address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years
Months
ADWELL
Adwell Financial Services Inc. Head Office:M1 - 4277 Kingsway, Burnaby, BC Vancouver: 604-363-2333 Calgary:587-355-2788 www.adwellfinancial.cor

Toronto:647-300-0768 Fax:604-620-6611

Payroll Frequency: Monthly/semi-monthly/ Bi- weekly/ weekly
Payroll Frequency: Monthly/semi monthly/
Each Payroll Amount
Name of Manager/HR
Contact No.
Previous Employer
Other Assets or Source of Income and Monthly Amount

Period with previous Employer(if applicable):YearsMonthsPrevious Employer:
Other Assets or Source of Income and Monthly Amount
*THIS SECTION MUST BE COMPLETED*

please sign here: please sign here
a)Have you ever been declared bankrupt? b)Have you ever been in consumer proposal before? c)If you have NO loans, debts or outstanding bills, please SIGN here: Please list all LOANS, OUTSTANDING CREDIT CARD BALANCES, OUTSTANDING BILLS, any other sums owed:
No
please sign here: please sign here

Yes No YesNoaHave you ever been declared bankrupt? bHave you ever been in consumer proposal before? cIf you have NO loans, debts or outstanding bills, please SIGN here: Please list all LOANS, OUTSTANDING CREDIT CARD BALANCES, OUTSTANDING BILLS, any other sums owed:
If you have NO loans, debts or outstanding bills, please SIGN here

Clear
please sign here

Clear
please sign here

Clear
Monthly Repayments (if not paying, say "None")

Is this new loan used to pay any of the followings?(Check if yes)

1. I authorize Adwell Financial Services Inc. to verify the information provided on this form as to my credit and employment history. 2.I am not indebted to any other credit union. bank, loan agency. or other third party either as a borrower or guarantor. except as stated previously on this application form. 3.I understand that if fail to repay the loan (default) I will be liable for all costs of recovery including legal costs. 4. I authorize Adwell Financial Services Inc. to carry out a credit bureau reference check if appropriate. (Note: A negative report will not necessarily effect your application if it has been declared above)Altematively, upon request by Adwell Financial Services Inc., I will obtain at my own cost a credit report from a company as specified by Adwell Financial Services Inc. for review. 5. The statements herein are made for the purpose of obtaining a loan and are true to the best of my knowledge. 6. The Applicant hereby gives consent to Adwell Financial Services Inc. Service to contact my employer(s) for the purpose of verifying my employment.

All your information will be subject to our Privacy Policy that can be provided on request. Signature of Applicant:Date:
Date

MonthDayYear
Date
The application cannot be processed until all the paperwork is complete and all required information and documents have been received.
Should be Empty:

(FOR OFFICE USE ONLY)

LOAN DETAILS

GUARANTOR/S

PERSONAL INFORMATION

CONTACT DETAILS

EMPLOYMENT INFORMATION

ADWELL