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Scheme: ¨ PCH ¨ PCP ¨ HP ¨ LP A
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Existing GE Customer (if any): ¨ Yes ¨ No Bank Name: _____________ Bank Branch:________________
If yes, please specify Account No: ______________________ Account No.: _____________ A/c Type: ¨ Current ¨ Savings
Joint Borrower: ¨ Yes ¨ No LLiiaab
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DDDeettaaiillss Loan Details:
Loan Type Loan Issuer bank/ EMI No. of O/S
Passport No: ______________ ___Expiry Date: D D M M YY YY
Amount Finance Co. EMI
Edbarah / National ID No: ____________________________
P
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Title: ¨Mr. ¨ Ms ¨ Mrs.: _______________________________________
(First) (Middle) (Last)

Date of Birth: D D M M YY YY Gender: ¨ Male ¨ Female Credit Card Details:

Residence in UAE Since: MM/YYYY Marital Status: ¨Single ¨Married ¨Other Issue Bank Limit Expiry date

No of Dependents: _________ Nationality: _____________________

Education: ¨ Below High School ¨ High School ¨ Diploma
¨ Graduate ¨ Post Graduate
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Employment Status: ¨ Salaried ¨ Self Employed ¨ New ¨ Used Milage / Kms: ______________
Organization Name: _________________________ Staff ID: __________ Make: _________Model:____ Year of Manufacture: _________
Monthly Salary/Income:___Other Income:____Salary Date: Price of Vehicle ______
Designation: __________________ Department:___________________ Other Charges / Accessories ______
Bus. Start Date/Date of Joining: Industry Type:_______ Motor Insurance Finance: ¨ Yes ¨ No Premium ______
Type of Ownership: ______Trade License No:____Issuing Authority:______ PPI Type: ¨ Gold ¨ Silver ¨ Bronze Premium ______
Flat/Villa No: _________________ Building Name: __________________ ___________Insurance: ¨ Yes ¨ No Premium ______
Street Name/ No:______________ Nearest Landmak: _______________ ___________Insurance: ¨ Yes ¨ No Premium ______
City: _________________ P O Box: ____________ Emirate: __________ Residual Value ______
Office: Extension: ______ Fax: Trade in Value ______
Office Email ID: ______________ Name of Sponsor: __________________ Down Payment ______
(If different from organization name)
Total Amount Financed
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drreessss Quotation / Valuation No:___________Date:
Flat/Villa No: _________________ Building Name: __________________ Chassis No: _______________ Engine No: _______________
Street Name/ No:______________ Nearest Landmak: _______________ Colour: ____________ Dealer Name: ___________________
City:________________________ P O Box: _______________________ Vehicle Registered in Name of: _________________________
Emirate:_____________________ At Current address since: MM / YYYY Registration Emirate: _________________________________
Residence Type: ¨ Rented ¨ Company provided ¨ Owned LLooaan
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¨ Mortgaged ¨ Sharing Tenor (T): _________ Repayment Date (each Month) ________
Residence: : Mobile: Flat Interest Rate: ____ Processing Fee_____________
Personal Email ID: ______________ Preferred Mailing Add: ¨Res. ¨Office EMI:_______________ Repayment Amount:_______
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Flat/Villa No: _________________ Building Name: __________________ ¨ SI ¨ PDC Bank Name:______________________
Street Name/ No:______________ Nearest Landmak: _______________ A/c No:______________ A/c Name:____________________
City:________________________ P O Box/PIN/ZIP: _______________ IIn
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State / Province:______________ Country:______________________ Insurance Company Name;___________________________
Mobile:(+) Tel. No: (+) Policy No:_______________ Renewal Date:
Contact Name: _______________________________________________ P
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n Friend’s Name: ___________ Friend’s Name: ___________
Friend’s Contact No: __/____ Friend’s Contact No: __/____
I hereby confirm all the information and documentation provided along with
this application are true, complete and accurate in all respects. I further FFoorr D
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authorize the JV to make enquiries and share information regarding my
application with credit bureau / agencies, institutions or any other person or Dealer Code _________________________
entity as the JV sees fit. I accept that JV is entitled in its absolute discretion Promotion Code _________________________
to accept or reject the application without assigning any reason whatsoever
and also agree the documents presented to JV will remain the property of Seller Code __________________________
JV.
Place: ________________ Fast Track No ___________________________
Date: ________________ Customer Signature