Suite 1, 8 Haughton Avenue

Kingston 10, Jamaica, W.I.

Tel: 906-2909/FAX: 906-7142
Email: customerservice@wilcofinance.com

BORROWER'S PERSONAL INFORMATION

Surname First Name Middle Name Alias / Nickname Gender

Date of Birth (mm/dd/yyyy) TRN Personal E-mail Address Telephone (Home) Telephone (Mobile)

Present Home Address Address Since (mm/dd/yyyy) Residence

Previous Home Address Address Since (mm/dd/yyyy) Residence

Name and Address of nearest relative not living with you

Relationship Telephone

No. of Dependents Marital Status Education Name of - Guarantor / Co-Borrower

Name and Address of Landlord / Mortgage Provider Telephone

Motor Vehicle - (make, model & year) Insurance Provider Estimated Market Value $:

How did you hear about WILCO Finance? Name of your Social or Civic Club Location of your Social or Civic Club

BORROWER'S EMPLOYMENT INFORMATION

Employer's Name Employed Since Occupation

Work Email Address Telephone Job Description

Name of Manager / Supervisor Telephone Work E-mail Address

Employer's Address Telephone (Office) Telephone (Mobile)

Previous Employer's Name Employed Since Occupation

Previous Employer's Address Telephone Job Description

SPOUSE'S INFORMATION

Name Employers Name Employed Since

Employer's Address Telephone Occupation

REFERENCES
1ST Referee's Name Telephone 2ND Referee's Name Telephone

Address Address

Employer/Occupation Employer/Occupation

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 MONTHLY INCOME & EXPENDITURE STATEMENT (J$)

Gross Salary/Income (Monthly) Net Salary/Income (Monthly)

Rent / Mortgage Entertainment

General Living Expenses Life Insurance Premiums

Transportation Total Monthly Utilities

Education Other Expenses

Medical Expenses Other Expenses

ASSETS YOU OWN (J$)

Description of Asset Amount $ Description of Asset Amount $

Real Estate Savings & Investments

Motor Vehicle Insurance-Cash Surrender Value

Furniture and Appliances Other Assets

LIABILITIES - MORTGAGES, LOANS, CREDIT CARDS (J$):

Mortgages, Loans and Name of Financial Branch of Financial Balance Monthly Payment
Credit Cards Institution Institution Owning($) Amount ($)

Mortgage(s)

Loan 1

Loan 2

Loan 3/Hire Purchase

Credit Card 1

Credit Card 2

Disclosure:
To the best of my/our knowledge, all information provided above is true as at date provided. Permission is hereby given for WILCO Finance Limited to undertake any
necessary activities relating to verification on information provided. Additionally, permission is hereby given for WILCO Finance Limited to share my personal, financial and
other information provided with relevant third-parties, in verifying information given &/or in procuring finance relating to this application. I/We hereby agree and commit to
advise WILCO Finance Limited of any future changes in the above information no later than next Payment Due date.

I/We hereby agree and commit to be bound by Borrowers Terms & Conditions, a copy of which I/We have received.

Borrowers Name Borrowers Signature Date

OFFICE USE ONLY (Comment Box):

Prepared by: Name: Approved by: Name:

Signature: Signature:
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