Loan Application Form

1

Desired Loan Amount ₹

2

Annual Income ₹

4

Name

Title

First Name

Last Name

5

Birth Date

6

Marital Status:

Single

Married

Other

7

E-mail

example@example.com

8

Phone

9

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

10

How long have you lived in your given address?

0-1 Year

1-2 Years

3-4 Years

5+ Years

11

Present Employer

First Name

Last Name

12

Occupation

13

Years of experience

0-1 Year

1-2 Years

3-4 Years

5+ Years

14

Gross monthly income

15

Monthly rent/mortgage

16

Down Payment Amount

17

Comments

18

Please List Here

19

I authorize prospective Credit Grantors/Lending/Leasing Companies to obtain personal and credit information about me from 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

20

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

YES