Tips

This section collects information about your Loan and Repayment details.

Loan Details

Tips

Please note that the application should be completed by the APPLICANT ONLY.

Please take care to answer all questions honestly and to the best of your knowledge.

This section collects personal and contact information about you.

Personal Information

Name:
Date Of Birth
National Registration Number:
National Insurance Number:
License Details:
Passport Details:
TAMIS Number:

Permanent Address

Contact Information

Telephone Numbers

Other Information

# of Dependents
Have you had a ANSA Merchant Bank Barbados Loan Before?
Do you require a Co-applicant?
Tips

Please take care to answer all questions honestly and to the best of your knowledge.

This section collects employment information for persons Employed/Self-Employed. For persons self-employed and contact information about you.

Please note with this option you must provide all supporting documentation, which include Job Letter and Pay Slip for Employed persons. For Self-Employed persons, 6 Months Bank Statements are required.

Current Employment Status

Monthly Income & Expenses
  Debit Credit
Income    
Gross Monthly Income  
Less Deductions (NIS, PAYE, MED. INS., PENSION, ETC.)  
Net Pay
Spouse's Net Income  
Other Income  
Total Net Monthly Income  
     
Monthly Expenditures    
Shelter (Mortgage, Insurance, etc.)  
1st Mortgage (including taxes) or rent  
2nd Mortgage  
Maintenance and Repairs to Property  
Insurance (Fire & Other Perils)  
Electricity  
Telephone  
Water  
Other  
Transportation (License, Bus Fare, etc.)  
Car License  
Car Insurance  
Car Operating Costs  
Public Transportation  
Living Expenses (Food, Clothing, MCTV, etc.)  
Food  
Clothing  
Medical & Dental  
Life Insurance  
Entertainment  
Other (Cooking gas, MCTV, etc.)  
Installment Obligations (Credit Cards, Loans, etc.)  
For Car
  
Spousal and/or Child Maintenance
  
Credit Cards
  
Other Loan 1
  
Other Loan 2
  
Other Loan 3
  
Monthly Savings/Investments:  
Total Monthly Commitments  
     
Surplus  
Assets (Values)CurrencyLocal
Currency
 BBD
Cash on Account$ 
Cash in hand$ 
Life Insurance (Cash Surrender Value)$ 
Real Estate$ 
Personal Effects$ 
Other$ 
Total$ 
Liabilities (Balances)CurrencyLocal
Currency
Loan 1
$ 
Loan 2
$ 
Loan 3
$ 
Mortgage
$ 
Credit Card Limit
$ 
Credit Card Balance
$ 
Total$ 
Net Worth$ 
THE UNDERSIGNED APPLICANT(S) HEREBY EXPRESSLY AUTHORIZE THE COMPANY TO OBTAIN SUCH FACTUAL AND INVESTIGATIVE INFORMATION REGARDING ME (OR US), FROM OTHERS AS PERMITTED BY LAW, INCLUDING CREDIT INFORMATION FROM CONSUMER REPORTING AGENCIES AND TO FURNISH OTHER CONSUMER CREDIT GRANTORS AND CREDIT BUREAU PARTICULARS OF THE CREDIT APPLICATION AND SUBSEQUENT CREDIT EXPERIENCE, IF APPLICABLE, AND RETAIN THIS APPLICATION AND INFORMATION FOR THE COMPANY’S RECORD.

Tips

Two close relatives or friends who MUST be residing in Barbados
(DO NOT use spouses, parents or co-applicant)

Please take care to answer all questions honestly and to the best of your knowledge.

Reference #1
Telephone Numbers

Reference #2
Telephone Numbers

Review Checklist

Before submitting your application, tick the checklist below to confirm that you have in your possession the listed items (where applicable). Please note that your application WILL NOT be processed without the required information. Once you are able to confirm you have all relevant items, bring them to the ANSA Merchant Bank Barbados along with the printed application form. If you do not have all relevant items, save the application and submit at a later date.