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VALOR BRIDGE FINANCIAL
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Loan Application
Date
Month
Day
Year
First name
*
Last name
*
Email
*
Position/Title
ID/Reg. Number
*
Birthday
*
Month
Day
Year
Tax Registration Number (TRN)
*
ID Type
*
ID Number
*
File upload: (TRN & IDs).
*
Upload File
Current Address
*
Length at Current Address
*
Previous Address
*
Length at Previous Address
*
Primary Phone Number
*
Secondary Phone Number
*
Marital Status
*
Number of Dependents
*
Next of Kin
*
First Name
*
Middle Name
*
Last Name
*
Address
*
Phone Number
*
Name of Employer
*
Department/Station/Company
*
Department Address
*
Phone Number
*
Length of Employment
*
Immediate Supervisor's Name
*
Supervisor's Position/Title
*
Phone Number
*
Applicant's Monthly Gross Income
*
Upload last three (3) Pay stubs.
*
Upload File
Other Income Type & Amount
*
Monthly Housing Payment (Rent/Mortgage)
*
Outstanding Debts ( List all loans, credit cards, loans of any kind, hire purchase, etc. give details of outstanding depts)
*
Loan Amount Requested
*
Purpose of Loan
*
Requested Repayment Term
*
Preferred Payment Method
*
Provide two personal references (not living with you). Must include First name, Last name, Relationship and Phone Number.
*
Signature: I certify that: - All information provided is accurate and current to my knowledge. - I authorize the lender to verify employment and contact references. - I understand that false statements may result in denial of this application.
*
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Date and time
Month
Day
Year
Time
:
Hours
Minutes
AM
Submit
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