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Personal Details
*
Surname Other Names
Date of birth*
Gender*
- Male
- Female
Marital Status*
- Maried
- Single
Nationality*
Passport No*
Driver’s License No*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone*
E-mail*

Employment Details
Type of Employment (Please tick)*
- Paid Employment
- Self Employed
- Others (Please Specify)
Company Name*
Company Address (Not P.O Box):*
Tel:*
Fax:*
Email*
(Guarantor)
Name:*
Relationship:*
- Yes
- No
Contact Address:*
Telephone:*
Email*
Introduced by:*
- Friend
- Relative
(Particulars of Bankers)*
Bank Branch
Tel. No*
Bank Verification No:*

Facility Details
Amount:*
Duration/ Tenor (in months):*
Purpose:*
Type of facility:
*
- Lease (Finance or Operating)
- Trade Finance
- Local Purchase Order
*
- Short Term Loan
- Project Finance
- Others (Specify)
Security Deposit:*
Please state your proposed Security, Collateral:*
This application is accompanied with a Processing Fee of:*
(A NON-REFUNDABLE PROCESSING FEE IS REQUIRED)
DECLARATION:
I certify that the above information and details provided are true and complete. I authorise you to make any enquiries which you may consider necessary for confirmation and your credit assessment.
Date:*
Signature*
FOR OFFICIAL USE
Verified by:
Name*
Date*
Signature*
INFORMATION PROVIDED WILL BE VERIFIED AND TREATED AS CONFIDENTIAL.