S.A.R.L. Bacchus… Immobilier & Insurance

Finance Requirement Form

PLEASE COMPLETE THE FOLLOWING: Questions with a * are obligatory.
      

First Borrower:
   Title: 
   First Name:   Surname: * 
   Date of Birth:     Nationality: 
   Marital Status:  
   Address: 
	    
   How long at this address ?:  
   Email: *  
   Tel:  (home) * 		Fax:  	
   Tel:  (work)   		Mobile: 

   Employer:  
   How long in this occupation ?:  
   Position:  

   Gross Monthly Income - Euros:  
   Gross Monthly Income - Other Currency:  
   Monthly Repayments on Existing Mortgage/Loans - Euros:  
   Monthly Repayments on Existing Mortgage/Loans - Other Currency:  


Second Borrower:
   Title: 
   First Name:    Surname: 
   Date of Birth:     Nationality: 
   Marital Status:  
   Address: 
	    
   How long at this address ?:  
   Email:  
   Tel:  (home) 		Fax:  	
   Tel:  (work) 		Mobile: 

   Employer:  
   How long in this occupation ?:  
   Position:  

   Gross Monthly Income - Euros:  
   Gross Monthly Income - Other Currency:  
   Monthly Repayments on Existing Mortgage/Loans - Euros:  
   Monthly Repayments on Existing Mortgage/Loans - Other Currency:  


Purpose of Loan:
   Loan Required (min. Euro €50.000):    
   Term Required:    

   House Purchase   House Renovation
   Other Project - Please State 
   Principal Residence  Secondary Residence  Buy to Let  House Construction
   Project Address:
 		 

   	When is the finance required ?
		
   	Where did you hear about us ? 
		
   	Bacchus Reference (if known) ?
		
   	Other comments: