(@® Assessment and Consent Form - Retail Financing opens Customer Full Name Tnioducer name INRIC No, /10 No. ico. Date of rth OOOO OOO vm stato Na contact No. roa) PART A: APPLICANT BACKGROUND INFO mame of employer ‘postion iy Employment status Glrermanent Cl contact C) Temporay CI seftemployed C2) other iM Edvation Quaifation Drrotessonst Cl oegee 2 dipoma Clothes Maral sates Disie CO manied others i Spouse Name of Employer on ‘i Spouse Postion on PART 8: FACILITY APPLICATION DETAILS []Primy [Jot Arpletion Tiler Name: Name: ‘}ase racity ype Application] Morzage C1] PenonalFnancngs! CE] other (nearest 850 Product Appiation (he mas spr inate, oan, te Vi MeseroductProftmate [I] FnedRate int /Proft ate fe 393-420¢0) Aopliation ese sete) Ti varabenate —int/ProfeRate: “BUR pi minus K 4e.25-45<0) (ese selec) wiFinancingAmount AMOI, 00,000.00 ee sano) vi Financing Tenure: COI) mth e.2¢ se) PART C: APPLICANT INCOME / COMMITMENT DETAIS os nce mu month InWetincome AM permonth i ter team Yon) ‘DSR SPECIALIST UNIT USE Type otincome Income a pero PASS / FAIL a mM, » mM, a ma a mM a mu ‘Financing Setiement oh naa nto / apse compen et fom) Type of Financing Deduction Amount Ourstanding Balance Franc nsttion Name 2 mw permth RM, oy mM permth RM, a. aw. permth RM, a a permth RM, 2 ru, ermth RM, PART D: CCRIS INFORMATION 1 Appleton Ret No, / CF No, ade fer! 5) Purpose of Financing i Piety Sect |W Francng Concept “tern ot wah ion Wrwdwerietmien ew CC) OOO OOoOo ‘reper tiee PART E: DECLARATION {Pre ety ene MAS ree st tape ect my epi MES et ot i ye ine of ce oe ee rea ‘ef mf etn re. Marea uted as format pat nym her ey on pot tm ptn ti on yh) ed soem a coed i Sirocmegemamemeeemeseed | parted eo