LOAN APPLICATION FORM

Application date......... .........______________ ....Application No. _____________

Presented to: ......... :::::::::.______________ .....Customer .No. _____________

According to my information as follows, I am presenting the loan aplication form, with the request which I would like to be taken into consideration.

( To be filled in by the customer )

Loan Data

Amount................................ ________ ..Currency ( 00)

Destination............................_________________

Period .................................._________________

Monthly ability to pay............. _________________

Personal Data

Name, Surname ....................._________________

Date of Birth.........................._________________

Address................................_____________________________________________

Nationality............................._________________

Pass. No .............................1_________________

Nr. Tel.Fax, e-mail.................._____________________________________________

Education.............................._____________________________________________

Legal Status of the Borrower

Name...................................._________________

Reg. in Commercial Ledger........._________________

Fiscal Code ..........................._________________

NIPT....................................._________________

Business Data

Briefing Description................ .____________________________________________ _______________________________________________________________________

Business Address ...................____________________________________________

..........................................Year 3 .........Year 2 ...........Year 1

Fixed Assets .........................______..........______...........______

Working Capital .....................______..........______...........______

Long Liabilities........................______..........______...........______

Short Liabilities.......................______..........______...........______

Annual Turnover .....................______..........______...........______

Net Profit ..............................______..........______...........______

Colallateral Available..........._______________________________________________

for this loan...................... .._______________________________________________