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CONSOLIDATED FINANCE COMPANY LIMITED PROPOSAL FOR INSURANCE PREMIUM FINANCING
Full Name:		Date Of Birth:
ID:
Address:
Telephone (h):	(w):	(f):
Current Employer:
Address:
Occupation:		Length:
Gross Salary : $   Expenses: $   Disposable Income: $
Banker:
Address:
Insurance Company:
Class of Insurance:
Vehicle Financed:     Yes    No	Mortgagee:
Payment Options:     Post Dated Cheques     Standing Order     Salary Deductions
I/We declare the Information submitted herewith to be true.
Signature:		Date:

FOR INTERNAL USE ONLY Purpose for which item will be used: Central Bank Classification Pervious Borrowing: Yes  No Experience:   E   VG   G    F   P Current Borrowing: Yes  No Part Of Group: Yes  No If yes, contact Nos. & Balances: If yes, Identify: Interviewed: Approved: