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Personal Statement of Affairs PSOA Personal Client Form

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Personal Statement of Affairs PSOA Personal Client Form Powered By Docstoc
					                                                                                                                                                         Form 11102 BAR (01/2010)

                                                                                                                    PERSONAL LOAN APPLICATION OR
                                                                                                                            STATEMENT OF AFFAIRS
                                                                                                      This application is the property of RBC Royal Bank (Barbados) Limited
BRANCH:                                                                                         ACCT. OFFICER CODE:              NEG FEES:                          DATE (YYYY/MM/DD):

AMT OF LOAN REQ.:                                                                               PURPOSE OF LOAN:

VISA ACCT NO.:                               CUSTOMER MASTER NO.:                               NATIONAL INSURANCE NO./NATIONAL I.D.:            MASTERCARD ACCT NO.:

DRIVER’S LICENSE NO.:                        EXPIRY DATE (YYYY/MM/DD):                          PASSPORT NO.:                                    EXPIRY DATE (YYYY/MM/DD):


PERSONAL INFORMATION
NAME (PLEASE PRINT)                                                  DATE OF BIRTH (YYYY/MM/DD)                            AGE            MARTIAL STATUS                 NO. OF DEPENDENTS
                                                                                                                                                                         (INCL SPOUSE)
HOME ADDRESS – NUMBER, STREET, CITY                   POSTAL BOX     SINCE (YEAR)        TELEPHONE NUMBERS                                SPOUSE’S NAME                        DATE OF BIRTH
                                                                                         Home:                   Cell:                                                         (YYYY/MM/DD)
                                                                                         Work:
NAME & ADDRESS OF LANDLORD (IF RENTING)                                  PREVIOUS ADDRESS                                                                                     YEARS THERE



NAME OF PERSONAL REFERENCE – IMMEDIATE FAMILY PREFERRED                  ADDRESS – STREET, CITY, P.O. BOX                  TELEPHONE NUMBERS                            RELATIONSHIP
                                                                                                                           Home:               Cell:
                                                                                                                           Work:
NAME OF PERSONAL REFERENCE – IMMEDIATE FAMILY PREFERRED                  ADDRESS – STREET, CITY, P.O. BOX                  TELEPHONE NUMBERS                            RELATIONSHIP
                                                                                                                           Home:               Cell:
                                                                                                                           Work:
NAME OF BANK OR FINANCIAL INSTITUTION                                    HAVE YOU ANY JUDGEMENTS OR           YES        IF YES, SEE PAGE 2  INDIRECT LIABILITIES (GUARANTEES    YES
                                                                         LEGAL PROCEEDINGS AGAINST YOU?       NO           FOR DETAILS     OR ENDORSEMENTS FOR OTHERS)         NO
HAVE YOU EVER BORROWED          IF YES, WHERE AND WHEN                   AMOUNT           HAVE YOU HAD ANY PREVIOUS LOANS            IF YES, WHERE AND WHEN                   AMOUNT
BEFORE FROM ANY SOURCE?                                                                   FROM THE ROYAL BANK?
   YES          NO                                                                            YES      NO

EMPLOYMENT INFORMATION
NAME & ADDRESS OF EMPLOYER                                                                TELEPHONE             EMPLOYMENT DATE
                                                                                                                (YYYY/MM/DD)         PRESENT ANNUAL SALARY OR WAGES

OCCUPATION                                 POSITION                                       EMPLOYEE NO.
                                                                                                                                          RENT:       50%    75%
PREVIOUS EMPLOYER                                                                                               EMPLOYMENT DATE
                                                                                                                                      OTHER
                                                                                                                (YYYY/MM/DD)
                                                                                                                                     INCOME              (SOURCE)
NAME & ADDRESS OF SPOUSE’S EMPLOYER                                                       TELEPHONE             EMPLOYMENT DATE
                                                                                                                (YYYY/MM/DD)    SPOUSE’S ANNUAL SALARY OR WAGES

OCCUPATION                                 POSITION                                       EMPLOYEE NO.
                                                                                                                                                  TOTAL ANNUAL INCOME           $ 0.00
PREVIOUS EMPLOYER                                                                                               EMPLOYMENT DATE
                                                                                                                (YYYY/MM/DD)                  TOTAL MONTHLY INCOME             $ 0.00

FINANCIAL INFORMATION

                        ASSET                                AMOUNT                                 LIABILITIES                                   AMOUNT                   MONTHLY PMT
CASH (ROYAL BANK)                                                                  (LOANS, MORTGAGES, CREDIT CARDS. ALL OTHER DEBTS)
                                                                                   MORTGAGE              RENEWAL DATE (YYYY/MM/DD)
CASH (OTHER)

LIQUID INVESTMENTS (STOCKS, BONDS, ETC.)                                           BANK LOANS – ROYAL
                                                                                   BANK LOANS – OTHER

LIFE INSURANCE –                                                                   LOANS – CREDIT UNION
FACE AMOUNT                PAYABLE TO
                                                                                   LOANS – INSURANCE CO.
                                                                   csv
OTHER LIQUID ASSETS (SPECIFY)                                                      CREDIT CARDS – VISA ROYAL – LIMIT $
                                                                                   CREDIT CARDS – OTHER – LIMIT $
REAL ESTATE                                                                        OTHER DEBTS (SPECIFY)


AUTOMOBILE
YEAR AND MAKE
YEAR AND MAKE
FURNITURE
OTHER                                                                              MONTHLY RENT (IF APPLICABLE)
OTHER                                                                                                                       SUBTOTAL              $ 0.00
OTHER                                                                                                                         SURPLUS             $ 0.00
                                           TOTAL            $ 0.00                                                          TOTAL               $ 0.00                      $ 0.00
REAL ESTATE OWNED - LOCATION                          REGISTERED - OWNER                  YR PURCHASED        PURCHASE PRICE                  VALUE                  EQUITY         FIRE INS




APPLICABLE LOAN TYPE     INTEREST RATE VALID UNTIL          ROYAL BANK PRIME PLUS     %                                    PAYMENT                TERM                     AMORTIZATION
                                                            ROYAL BANK PERSONAL LOAN BASE RATE PLUS                 %
                            /        /                      FIXED     %


                                                                                                                                                                                 Page 1 of 2
                                                                                                                                                                       Form 11102 BAR (01/2010)

I/We warrant and confirm the information given herein is true and correct and I/We understand it is being used to determine My/Our       PAYMENT IN MONTHLY INSTALLMENTS
credit responsibility. I/We further confirm that no information, which might affect the Bank's decision to make the loan, has been
withheld. I/We hereby authorize and consent to the Bank receiving and exchanging any financial and other information which it may           BEGINNING ONE MONTH FROM DATE OF NOTE / AGREEMENT
have in it's possession about Me/Us with any of it's subsidiaries, agents, third party assignees, other financial institutions, Credit      BEGINNING -       /        /
Bureaus or other person of Corporation or with whom I/We may have or propose to have financial dealings from time to time. I/We
indemnify the Bank against any loss, claims, damages, liabilities, actions and proceedings, legal and or other expense which may be         MATURITY DATE -        /         /
directly and reasonably incurred as a consequence of the disclosure of the financial information. My/Our deposit account may be
charged with the monthly payments as they mature and I/We agree to pay your customary assessment for any notices of overdue
installments.


                                  APPLICANT’S SIGNATURE                                                                                    CO-SIGNOR (SPOUSE ONLY)

SOURCE OF BUSINESS
     NEW                         REFINANCE                       FORMER                     NEWSPAPER                     RADIO                       TV                             OTHER (SPECIFY)
     MAIL DROP                   DIRECT MAIL                     WALK IN                    SIGN                          STAFF REFERRAL              CLIENT REFERRAL
JUDGEMENTS OR LEGAL PROCEEDINGS (PARTICULARS)

INDIRECT LIABILITIES (PARTICULARS)



INVESTIGATION
EMPLOYER CONFIRMS                                                                                       SALARY VERIFICATION/CONFIRMATION DETAILS:
     POSITION         INCOME          SERVICE
PREVIOUS EMPLOYER CONFIRMS
     POSITION         INCOME          SERVICE
SPOUSE’S EMPLOYER CONFIRMS
     POSITION         INCOME          SERVICE
LANDLORD / MORTGAGE HOLDER
     MO. PAYMENT          YEARS THERE            PAYING HABITS –           GOOD /       SLOW
     LIFE INSURANCE                   APPRAISAL

EXISTING CREDITORS (Verify standing of account with all creditors.)

NAME OF COMPANY / BANK                TELEPHONE        DATE ACCT OPENED           HIGH CREDIT           TERMS             BALANCE           RATING        OTHER INFORMATION OBTAINED

                                                             /        /
                                                             /        /

RECORD PARTICULARS OF LAST CHECK COMPLETED
                                             CONFIRMATION                                               DATE ACCT                                                          PRESENT
         GENERAL INFORMATION                                         REFERENCE CHECKED                                       HIGH CREDIT             TERMS                                 RATING
                                               YES      NO                                               OPENED                                                            BALANCE
AGE
                                                                                                            /       /
ADDRESS
                                                                                                            /       /
EMPLOYER
                                                                                                            /       /
SALARY
                                                                                                            /       /
INVESTIGATOR’S REMARKS                                                                                                                                                                  NO. OF YEARS
                                                                                                                                                                                        RBC CUSTOMER


COLLATERAL SECURITY                                                                                                                                                                        INITIALS
     HELD    TO BE OBTAINED          BEING SENT
SHOW FULL PARTICULARS FORM NO. AND
DESCRIPTION OF SECURITY.                               }
ENDORSEMENT(S) AND/OR CO-SIGNER(S) (ATTACHED S.O.A.)

INSERT NAME(S) AND THE DEGREE
OF PROTECTION AFFORDED SUCH
AS NET WORTH, ETC.
                                         }
TOTAL DEBT SERVICE RATIO                               TOTAL MONTHLY PAYMENTS INCLUDING NEW LOAN                                             X 100 =              % (should not exceed 40%)
(SPOUSE MUST CO-SIGN IF INCOME BEING USED)             GROSS MONTHLY INCOME



INFORMATION CHECK LIST               AUTOMOBILE INSURANCE VERIFIED                                              REGISTERED CHATTEL MORTGAGE                  SALARY ASSIGNMENT
                                     CHATTEL MORTGAGE ON MOTOR VEHICLE TAKEN /                                  SPOUSE’S COVENANT HELD                       SALARY DEDUCTION -
                                     BILL OF SALE ON MOTOR VEHICLE TAKEN


REFINANCE         LOAN #                TRANSIT #:                  LOAN NOTE DATE -           /        /                      LOAN #                              TRANSIT #:

     CREDIT A/C #                       TRANSIT #:                                                                             DEBIT A/C #                         TRANSIT #:


CREDIT BUREAU RESULTS:



                                                                                                                                                                                          APPROVING
                                                                                                                                                                                           OFFICER
                                                                           CREDIT POLICY EXCEPTIONS                                         NAME AND SIGNATURE

®
    Registered trademark of Royal Bank of Canada. RBC Royal Bank of Canada is a registered trademark of Royal Bank of Canada.                                                             Page 2 of 2

				
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