Signed-Customer Information Form ( CAR )

Source: __________
Sale-person: Signed Date:

Supervisor Sign: Channel:

Customer Information

Name: Phone:

Spouse Name: Phone:

Current Address:

Loan Requirement Information

Required Amount: Period:

Other Required:

Car Information
Buy a car:
Brand New Car 口 Used Car (Plate Number) 口 Used Car (No Plate Number) 口
Model: ________________ Year: ________________ Price: ________________
Car Mortgage:
Model: ________________ Car Owner Name: ________________
Year: ________________ Bought Price: ________________
Can provide a guarantor? Yes 口 _________________ No 口

Other Liabilities
1) Loan Channel ______________ , Loan Type ______________ , Amount ______________ ,
Remain Amount ______________ , Montly Installment Payment ______________ .
2)

CBC

Loan Usage

Other Information