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Monthly Income & Expenditure
  1. No. of Children & other Dependents
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  2. Gross Monthly income (member:)
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  3. Gross Monthly income (spouse:)
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  4. Statutory & Other Deductions:
  5. (NIS, NHT, I/TAX, etc.) (1) :
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  6. (NIS, NHT, I/TAX, etc.) (2) :
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  7. Net Monthly Income:
  8. Expenditure:
  9. Hire Purchase:$
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  10. Loan Repayments (C.U., Bank, Gov't):$
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  11. Insurance Premiums (Health, Life):$
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  12. Housing (Rent, Lease, Mortgage):$
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  13. Grocery & Household Supplies: $
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  14. Utilities (Gas, Light, Water, T/Phone):$
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  15. Transportation (a) Private (inclusive of tyres, repairs Insurance [yrly/12]):$
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  16. Transportation (b) Public (taxi, bus etc.):$
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  17. Educational Expense (self/ dependents):$
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  18. Savings (contractual arrangement) e.g. C.U., Bank, Partner etc.):$
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  19. Other (Day Care / Household Help/ Child Maintenance etc.):$
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  20. Total Expenses:$
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  21. Debt Ratio:
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  22.  
  1. Member's Information:
  2. Name of member:
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  3. Address of Member:
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  4. Home:(*)
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  5. Work:(*)
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  6. Cell:(*)
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  7. Member's Date of Birth:
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  8. Name of Spouse:
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  9. Name, address and telephone no. of your nearest relative (excluding spouse):
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  10. Loan amount required:
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  11. By what payment method will you repay this loan:
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  12. Employment Information:
  13. You are employed by?:
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  14. What is your work address?:
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  15. What is your position at work?:
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  16. How long have you worked at this job?:
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  17. If self employed what kind of work do you do?:
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  18. How do you get paid? Weekly, Fortnightly or Monthly?:
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  19. Do you have any source of additional income?:
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  20. How much do you earn as additional income?:
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  21. Spouse or Co-Applicant's Information:
  22. Where does he/she work?:
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  23. How long?:
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  24. Tele no:
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  25. Address of workplace:
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  26. What is his/her position at work?:
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  27. Member's Declaration:(*)
    You must agree, before submitting the form!