Loan Application

To start your loan application process, fill in the online form below. Once completed, be sure to carefully review the form before you click submit.

Business Details

Business name: *
Business Telephone Number(s): * eg. 876-555-5555 extn. 5555	Business Fax number(s):
Registered Address Line 1: *	Registered Address Line 2: for example Kingston 11
City/District: *	Parish: *

TCC

TCC Number:

Please enter a valid TCC e.g 123445964.

TCC Expiration Date:

Please enter the expiration date of your TCC.

TRN: *

e.g 109245197

Primary Contact Information

First Name: *	M-I:	Last Name: *
Direct Line: *		Cell Number:
E-mail: *

Principal Business Activity: *	Other Principal Business Activity:
Further information: Please enter any specific information you have on the type of business you operate.

Financing Requested

Amount of Loan: * Please enter only numbers, no letters or symbols.	Currency: * $US $JA	Repayment Period Requested: *
Requested Moratorium: Applied only to interest payments

Purpose of the Loan: *

Have you ever borrowed from the EXIM Bank?: *

YES

Proposed Collateral: *

Other Proposed Collateral:

Proposed Collateral:

Other Proposed Collateral:

Proposed Collateral:

Other Proposed Collateral:

Plant Location

Enter this information only if address is different from registered address.

Address line 1:	Address line 2: for example Kingston 11
City/District:	Parish:

Legal Status of Business: *

Year of Incorporation: *

e.g. 1984

Principal Officer(s)

Information for at least one (1) principal officer is required.

Title	Name	TRN	Age	Gender
				M F
				M F
				M F
				M F
				M F

Principal Shareholders

All Shareholders with over 25% shareholding must be identified.

Name	Nationality	TRN	Active/Passive	% Shares
			A P
			A P
			A P
			A P
			A P
			A P
			A P
			A P
			A P
			A P

Add more

Directors

Information for at least one (1) director is required.

Name	Nationality	TRN

Add more

Affiliated Companies (if any)

Name of business:	Type of affiliation:
Other Affiliated Company:

Name of business:	Type of affiliation:

Other Affiliated Company:

Name of business:	Type of affiliation:
Other Affiliated Company:

Name of business:	Type of affiliation:
Other Affiliated Company:

Name of business:	Type of affiliation:
Other Affiliated Company:

Banking Information

Principal Banker: *	Branch: *
Contact Person:

Number of Employees

Current Number: *

Projected if approved: *

Fire, Allied & Peril Insurance

Is FAP Insurance coverage in place on your business?: YES NO
Name of Insurance Company:	Coverage Amount: $ Digits only, no punctuation, round to nearest dollar (e.g 10000)
Expiration date of Policy:
Address of Insurer
Address line 1:	Address line 2: for example Kingston 11
City/District:	Parish:

Liabilities to Other Financial Institutions

For amount owed please use digits only (no commas) and round up to the nearest dollar, e.g 100000.

Financial Institution	Amount Owed	Rate of Interest	Repayment Period
	$	%
	$	%
	$	%

Are there any current, pending or threatened legal proceedings against the company before any court or administrative agency?:

YES

Please provide details on any current, pending or threatened legal proceedings against the company:

Please review the form carefully before submitting.

Type the characters, from the picture above, into the box below: *

Copy the characters (respecting upper/lower case) from the image.

Last Modified: 10/09/10 9:34 AM