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CAPITAL RELIANCE MONEY LENDING SERVICES

CORPORATE LOAN APPLICATION FORM SECTION A

COMPANY DETAILS

Company Name: Company Registration Number: Represented by Position Type of Company (Please check one) Limited Liability [ ] Limited by Guarantee [ ] Other [ ] Location of business.. Nature of business.. Postal Address............................ E-mail. Physical Address.

Telephone/ Fax

Telephone 1 Telephone 2 Facsimile

SECTION B

LOAN DETAILS

Amount: GHC Amount in Words:. Purpose..

Loan Term 3 Months 6 Months 9 Months

PROPOSED SECURITY/ COLLATERAL

Security type Location Est. Market value Est. Forced sale value

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SECTION C OWNERSHIP DETAILS

OWNERSHIP Name Nationality Shareholding (%)

BORROWING HISTORY ( Last Two Years) Institution Amt. Borrowed (GHC) Date Borrowed Monthly Instalment

(GHC) Outstanding Balance

(GHC)

DIRECTORS Name Date of birth Nationality Position Number of years in above position Number of years with company Number of years working life Educational background

Contacts Telephone (Office) Mobile phone 1 Mobile phone 2 Residential address

Accommodation rented or owned

Mailing address (Box Number)

E-mail address

Please underline applicable ID type ID type(Passport/Dr licence/voters ID) Place/ Issue date Expiry date

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MANAGEMENT

Name

Date of birth

Nationality

Position

Number of years in above position

Number of years with company Number of years working life Educational background Contacts Telephone (Office) Mobile phone 1 Mobile phone 2 Residential address

Accommodation rented or owned

Mailing address (Box Number)

E-mail address

Please underline applicable ID type ID type(Passport/Dr licence/voters ID) Place/ Issue date Expiry date

SECTION D

BANKERS INFORMATION

Current Bankers

Bank Branch Address

Signatories

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DECLARATION In support of our loan application, we set out the above information, which is true and correct to the best of our knowledge. We understand that if any of the information we have provided proves to be false, it will lead to the automatic decline of our application. We consent to CAPITAL RELIANCE MONEY LENDING SERVICES, in connection with this loan application, making such enquiries about our affairs as it deems fits, including relations/operations with our bankers. We will also be available for further discussions on my request, if need be.

Name Signature Position Date .. . ...