HAMPTONS INTERNATIONAL MORTGAGES ( THAILAND ) 005
CLIENT NAME: MARITAL STATUS: DATE OF BIRTH:
NATIONALITY: ID / PASSPORT NO: RESIDENCY STATUS:
CURRENT ADDRESS:
TELEPHONE NO: MOBILE NO: FAX NO:
         
DEPENDENTS:        
1) AGE CURRENT SCHOOL COSTS PA FUTURE SCHOOL FEES PA
2) AGE CURRENT SCHOOL COSTS PA FUTURE SCHOOL FEES PA
3) AGE CURRENT SCHOOL COSTS PA FUTURE SCHOOL FEES PA
4) AGE CURRENT SCHOOL COSTS PA FUTURE SCHOOL FEES PA
5) AGE CURRENT SCHOOL COSTS PA FUTURE SCHOOL FEES PA
PRESENT EMPLOYER: YEARS POSITION HELD
PREVIOUS EMPLOYER: YEARS POSITION HELD
NAME OF SPOUSE MARITAL STATUS DATE OF BIRTH:
NATIONALITY ID / PASSPORT NO: RESIDENCY STATUS:
TELEPHONE NO: MOBILE NO: FAX NO:
CURRENT ADDRESS:
PRESENT EMPLOYER: YEARS POSITION HELD
PREVIOUS EMPLOYER: YEARS POSITION HELD
AMOUNT OF LOAN SOUGHT: US$/HK$/STG/AUD IN THAI BAHT FOR A TERM: YEARS
PURPOSE: ASSIST PURCHASE/REFINANCE OF PROPERTY AT (ADDRESS) PROPERTY TYPE:
TO BE OWNED BY PURCHASE PRICE/VALUE
CURRENT LIABILITIES AUD/HKD/STG/USD*
HOME MORTGAGE DEBT WITH:
OTHER DEBTS  
FUTURE LIABILITIES  
TOTAL LIABILITIES  
TOTAL LIABILITIES   AUD/HKD/STG/USD*
HOME
LOCATION PROPERTY TYPE
COST ACQUIRED DATE
CURRENCY    
OTHER PROPERTIES:    
BANK BALANCES (DETAILS)    
BANK    
BRANCH    
A/C NO.    
ACCOUNT NAME    
BONDS      
SAVINGS PLANS      
OTHER ASSETS      
TOTAL ASSETS      
SOURCES OF INCOME
AUD/HKD/SDG/USD/GBP/OTHER
MONTHLY
 
CURRENT INCOME
SALARY/WAGES
SPOUSE
(GROSS$ P.A.)
OTHER INCOME
TOTAL MONTHLY INCOME
FUTURE INCOME  
PENSION / SUPER PLANS
TOTAL EST'D RETIREMENT INCOME
 
SOURCES OF EXPENDITURE
AUD/HKD/SDG/USD/GBP/OTHER
MONTHLY
 
GENERAL LIVING
EXPENSES
REPAYMENTS ON OTHER
CREDIT ARRANGEMENTS
RATES & TAXES
TOTAL MONTHLY COMMITMENTS
OTHER DETAILS    
SOLICITOR'S NAME OF FIRM
ADDRESS
PHONE FAX
  1. I/We agree that all personal data relating to the Account Holder/Applicant collected by Hamptons International Mortgages Thailand Limited (hereinafter referred to as HIMT) from time to time may be used and disclosed for such purposes and to such persons as may be in accordance with HIMT's policies on use and disclosure of personal data set out in statements, circulars, terms and conditions or notices (either verbal or in print) made available by HIMT to its customers from time to time and such data may be (i) used in connection with matching procedures (as defined in the Personal Data (privacy) Ordinance and (ii) disclosed (by way of bank references or otherwise) to any financial institution with which the Account Holder/Applicant has or proposes to have dealings to enable such financial institution to conduct credit checks on the Account Holder/Applicant.
  2. I/We understand that failure to provide information may result in HIMT being unable to provide services requested.
  3. I/We declare that the details presented in this application form are true and complete in all respects. In assessing the decision regarding granting of the request sought, I/We acknowledge that HIMT may make any other inquiries which HIMT considers necessary.
DATE

SIGNATURE(S) APPLICANT(S)

 
*Delete as applicable*