Application form. Application for Mortgage Loan. 1. Personal information. amortization mortgage % interest mortgage life insurance % interest

Transcription

1 Application for Mortgage Loan Application form Please fill in completely and check where applicable. Please include an appraisal report. 1. Personal information Name and first names (in full) Address Residence d. Telephone number e Date of birth f Nationality g. Marital status; If you re single, are you getting married soon? If so, what is the wedding date? h. Giro, bank account number i. ID number j. address k. Profession/function l. Employer m.name and first name (future) spouse n. Date of birth o. ID number p. Profession q. Who is his/her employer? r. Does he/she hold a permanent appointment? s. Are or have there been prenuptial agreements drawn up? t. Have you been married before? u, Has your (future) spouse been married before? v. Is there a divorce or separation case pending? w. Do you have children living at home? If so, how many and what is/are the age(s)? x. What is your total gross annual income? y. And that of your (future) spouse? amortization mortgage % interest mortgage life insurance % interest 1. d. e. f. g. married single yes no Date: / / h. i. j. k. l. Name bank: Located in: m. n. o. p. q. r. yes no s. yes no t. yes no u. yes no v. yes no w. yes no Number of children: Ages: x. y.

2 2. Mortgage loan Amount of the requested loan Monthly annuity/interest For what purpose do you need this mortgage? d. What is the extent of your private means? e. By what dat approximately is the loan requested? (NB the accurate date can only be dtermined after consultation with the notary and the lender.) 2. d. e. Date: f. By which notary will the deed be passed in due time? 3. Life insurance New insurance to be taken out Capital Length Do you already have (a) life insurance with fatum? If so, must this/ these insurance(s) be contributed to the insurance being petitioned? f. Name: Address: 3. Amortization mortgage years mortgage life insurance years yes no yes no Give a specification of your life insurance policy(-ies) Name company Policy number Capital Rate Final date 4. Description of the real estate to be linked What is the nature and purpose? What is the appraised value? d. e. At what address is the real estate located? What is the surface area of the ground? Is the ground (being) acquired in full ownership/ ground lease? 5. Existing structure When was the collateral built? What was the purchase price?(without personal estate and expenses) Are you already owner of the property? If so, is there a mortgage on the property? Who then is the current lender? d. What is the amount of the outstanding debt? e. Is the property inhabited? If so, by whom? 4. incl. ground excl. ground Address: City: d. m 2 e. yes no 5. Date: yes no yes no Name: d. e. yes no Name: Phone number:

3 6. Specification of the proposed work in the renovation or improvement at the property Nature of the work 6. Cost Total Application form * Attach drawings with technical description and proposals 7. New house How far is the construction? Approximetly what date will construction be competed? How much are: The purchase price of the ground Construction costs Architect s costs Cost additional work (to be specified) Total Illustration, if desired: 8. Fire insurance Is the collateral insured againt fire? If so, with which company and in what amount? In case fire insurance has not yet been taken out, the buildings must be insured based on the reconstrution value, against extended risk policy on an index basis, with our company at the latest on the date on which the mortgage deed is passed on to your name, in so far as the risk is acceptable. The same goes for increases. Date: 7. Date: NB Attach specifications, drawings with layout indicating the location of the property, and proposals of the additional work. 8. yes no Name company: The petitioner declares to have answered above questions truthfully. Petitioner hereby agrees with direct debit via the bank/giro with regards to the premium lfe insurance and the redemption of the mortgage Signature policy holder: / / This translation has been issued for the convenience of our English speaking customers. The contract is exclusively governed by the Dutch wording of the policy.

4 U.S. Indicia As of July 1st 2014, all fi nancial institutions are required by law according to the Foreign Account Tax Compliance Act (FATCA) to provide the IRS (U.S. Tax Authorities) with information about customers who could have tax obligations in the United States of Americ As of 2015, Guardian Group Fatum forwards this information to the IRS. For more information on FATCA please visit U.S. Indicia INDIVIDUAL CUSTOMERS US Indicia Please check all those that apply: 1. U.S. citizenship (passport) or lawful permanent resident (green card holder) 2. U.S. birth place 3. U.S. address (residence, correspondence, or P.O. Box) 4. U.S. bank account or directions received regularly from U.S. address 5. U.S. telephone number 6. Only address on fi le is in care of or hold mail address or U.S. P.O. box (excl. foreign P.O. Box as U.S. indicia) 7. Power of Attorney or signature authority granted to person with U.S. address U.S. Indicia LEGAL ENTITY Please check all those that apply: 1. Are you a legal entity incorporated or formed in the U.S.? 2. Does your company have a U.S. registered offi ce or major place of business address in the U.S. 3. For Corporations: Does the Corporation have major shareholders, i.e. individual(s) who own 10% or more of the company, that are U.S. citizens or U.S. residents? 4. For Partnerships: Are one or more of the partners U.S. citizens (passport) or lawful permanent resident (green card holder)? 5. Are you a Financial Institution? If so, please provide the GIIN number. Provide information where applicable and provide copies (or scans of the document via indicia@dmyguardiangroup.com) Provide information where applicable and provide copies (or scans of the document via indicia@dmyguardiangroup.com) I hereby declare that none of the above is applicable. I hereby declare to have received and read the U.S. Indicia and that all information provided in this application and in documents submitted is true and correct. Signature: Date: Full name: Identifi cation or Passport number:

5 Ascertaining and verifying your identity Within the framework of national and international legislation and regulations, such as the prevention of money laundering and fi nancing of terrorism and the Offi ce for the Disclosure of Unusual Transactions, Guardian Group, and its affi liated companies such as Fatum Holding N.V., Fatum General Insurance N.V., Fatum General Insurance Aruba N.V., Fatum Health N.V., Fatum Life N.V. and Fatum Life Aruba N.V. (hereinafter referred to as: Guardian Group ), in its capacity of insurer (fi nancial service provider), is obliged to verify your identity. This enables us to establish whether the identity you have given us matches your true identity. The aforesaid means that Guardian Group will ask you, regardless of you being a private or business client, to identify yourself by means of valid ID/original documents, prior to providing you with a service or entering into a business relationship with you. Subsequently, Guardian Group will make clear (color) copies of your valid ID/original documents and arrange for you to sign and date these copies. These copies are deemed to form an integral part of your request and will be fi led in the dossier held by Guardian Group, together with this form. Any personal data will be stored by us in the Guardian Group client administration. The various regulators will ensure that Guardian Group, in its capacity of insurer and fi nancial service provider, will correctly and properly meet and fulfi ll its statutory obligations with regard to ascertaining and verifying your identity and, if (legally) required, the disclosure of personal data to third parties. The applicable diagram below is to be completed by a Guardian Group staff member or a Guardian Group intermediary. Valid IDs in the event of natural persons and/or executive legal persons* Policyholder Insured Premium contributor Beneficiary Number Rnwl date Number Rnwl date Number Rnwl date Number Rnwl date ID card (sédula) or Driver license or Passport (*) A copy of an (expired) ID card (sédula), driver license or passport is not accepted as valid ID. Original documents in the event of legal entities Policyholder Insured Premium contributor Beneficiary a) Extract from the Commercial Register of the Chamber of Commerce** and, among other things, b and c: b) Articles of Association and c) Shareholders register Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no Yes/no (**) A copy of an extract for the Commercial Register of the Chamber of Commerce and/or older than six (6) months is not accepted as an original document. (Yes/no) Delete as appropriate. To be completed by a Guardian Group staff member or a Guardian Group intermediary: I (full surname and fi rst name of Guardian Group staff member or Guardian Group intermediary***), herewith declare that I have accepted the original and valid ID/original documents referred to by me in the above diagrams, and that I have made clear (color) copies from these, which copies are deemed to form an integral part of the client s request and which will be added by me to the Guardian Group dossier. Country : Date : Signature : (***) Delete as appropriate. ARUBA L.G. Smith Boulevard 162 P.O. Box 510 Aruba Tel.: (297) Fax: (297) BONAIRE Kaya Gobernador N. Debrot 35 P.O. Box 152 Bonaire Tel.: (599) Fax: (599) CURAÇAO Cas Coraweg 2 P.O. Box 3002 Curaçao Tel.: (599-9) Fax: (599-9) SINT MAARTEN A.J.C. Brouwers Road 6 P.O. Box 201 Sint Maarten Tel.: (1-721) Fax: (1-721)

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