ERG-l
THE EMERGENCY RELIEF GUARANTEE FUND ACT, 1999
LOAN APPLICATION FORM
Approved Lender's Name:
Branch:
Purpose of Loan:
□repair damage property
□ replacement of destroyed property
2.
Applicant Details
Name of applicant:
Street Address:
P. O. Box:
Date of Birth:
Nationality :
Marital Status:
□ single □ married □ divorced □ other
Number of Dependants:
Ages:
Type of property:
□ freehold □ leasehold □ other
□ commercial □ residential
Name of co-applicant:
Street address:
P. O. Box:
Date of Birth:
Nationality:
Marital Status:
□ single □married □ divorced □ other
3.
Employment details
Applicant
Co-applicant
Name of Employer:
Address of Employer:
Years with present Employer:
Position held:
Monthly salary:
Name of previous Employer:
Years with previous Employer:
4.
Details of work to be done
Lot#:
Subdivision:
Island:
Current owner of property:
Property occupied at time of damage:
Brief description of work to be done:
To be completed by:
5.
Cost Estimates
Building
$
Furnishings
$
Insurance
$
Other (specify)
$
Connections (water, sewer, electricity)
$
Total
$
Down payment available
$
Loan Requirement
$
6.
Financial Status
Assets
Liabilities
Cash in bank (s)
Bonds & Securities
Cash surrender value (life
insurance)
Automobile(s) make & year
Real estate owned
Other assets
Total
$
$
$
$
$
$
$
Accounts Payable (describe)
Loans outstanding (describe)
Automobile(s) installment payment(s)
Mortgage loan owing
Other installment payments
Total
$
$
$
$
$
$
$
7.
Proposed Security
□ 1st mortgage on above mentioned propert