Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Exposure

VIEWS: 9 PAGES: 1

									LENDERS SINGLE INTEREST APPLICATION FORM

Institution Name: Address:
(Street) (City)

Number of Branches:
(State) (Zip)

Contact Name and Title: Phone: Exposure: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Current number of auto secured loans: Dollars Outstanding: $ How many auto secured loans did you make during the last 12 months? How many auto secured loans do you expect to make in the next 12 months? Percent Direct: % Percent Dealer: % Do you have dealers whose plan of operation is strictly full recourse? Yes No Percent: Maximum loan term: months Average loan term: months Average delinquency percentage: YTD % Last Year % Prior Year Do you make single payment loans? Yes No How is interest calculated? Simple Interest Pro Rata Rule of 78’s Do you make open-ended loans? Yes No If Yes, please explain: 11. Do you have an insurance follow-up program? Yes No Past Experience: 1. 2. 3. 4. 5. Number of repossessions: YTD Last Year Average repossession deficiency this year: $ Last Year: $ Skip losses last year: $ Number Prior Year: $ Has this insurance been carried previously? Yes No If yes, with whom (attach experience if available): Yes Watercraft Maximum balance to be insured: Current number of loans: Dollar outstanding: Est. number new loans next 12 mos.: $ $ No Recreational Vehicles $ $ Prior Year Prior Year: $ Number Fax: E-mail:

% %

Is coverage desired on other than autos?

Mobile Homes $ $ $ $

Motorcycles

Other Personal Chattels $ $

Has any application for single interest insurance ever been declined, cancelled or renewal refused? (Not Applicable in Missouri).

Yes

No

Dated at

this

day of By Financial Institution

, 20

Signature and Title

MFS LSI APP 8/4/2006

Page 1 of 1


								
To top