HEAD OFFICE
13 Barbados Avenue, Kingston 5, Jamaica, W.I.
Tel: (876)- 926-2669/ 754-4112
Fax: (876)- 960-2519
First Union Financial Company

In Service to the Employees and Entrepreneurs of Jamaica.

Branches: Branches: Montego Bay, Ocho Rios, Mandeville, Westmoreland, May Pen, Portland, Spanish Town, Linstead, Spanish Town Road, Ocean Boulevard

Instruction: Fill in the required information and click submit at the bottom.
Micro FIN APPLICATION FORM
PERSONAL INFORMATION
Firstname: Middle: Lastname:




Title Aliases: DOB:
[ dd/mm/yyyy ]
I.D. Type: I.D. No.:
TRN No.: Enter # without spaces
No. of Dependents
Home Address: How long at this address:

Years:
Tele. No.: i.e. xxx-xxx-xxxx Months:
Previous Address: How long at this address:  
Years:
Tele. No.: i.e. xxx-xxx-xxxx Months:
Name of Landlord/Mortgager: Address of Landlord/Mortgager: Tele. No.:
Names of other working members of household : Relationship: Occupation:
Name and Address of Employers of Working Household Members: Tele. No.:  
1. i.e. xxx-xxx-xxxx  
2. i.e. xxx-xxx-xxxx
3. i.e. xxx-xxx-xxxx
4. i.e. xxx-xxx-xxxx
YOUR EMPLOYER (If Applicable)
Nature of Company:

 

Address:
Tele. No.: i.e. xxx-xxx-xxxx  
Occupation:  
Time with Company: Years Months  
BUSINESS OPERATIONS
Name of Company: How long at this address:

Years:
Location: Months:
Business Activity:
Years in Operation:
Loan Product Type:  A C
B D
Sub-project classification:
Loan Amount: J$ Purpose of Loan:  
Loan Term: (Describe)
(Describe)
Number of Employees: List clients (neigbours, retail stores/market etc)
CURRENT  
Working Proprietors
Paid Employees M F
Unpaid Employees M F
SECURED BY LOAN    
Working Proprietors M F How are goods sold or how are clients for Services obtained?
Paid Employees M F
Unpaid Employees M F
Generated by Loan (New)    
Working Proprietors
Paid Employees  
Unpaid Employees  
List main suppliers (of  raw materials, finished goods)

Supplies obtained:

 
How are supplies transported to business location?
Who runs the business when you are sick or away?
List any threats to client base, goods supply, production or sales (e.g. new competition, irregular supplies labour problems etc.)
WHAT IS YOUR HOUSEHOLD FINANCIAL SITUATION
  Gross Monthly Income Source Name of Bank Branch
Applicant        
Working Member of Household        
BUSINESS INVENTORY OF MACHINERY & EQUIPMENT
Description Condition (very good, good. Poor) Age Value Amount owed
4.
BALANCE SHEET
ASSETS J$ LIABILITIES & NET WORTH J$
Cash Short Term Payables
Bank Machinery
Account Receivable Long Term Payables
Raw Materials Other Liabilities
Work in Progress    
Finished Goods NETWORTH
Business Machinery    
Business Real Estate Equity
Other Assets Retained Earnings
TOTAL ASSETS TABLE LIABILITIES & NETWORTH
Statement of Revenue & Expenses (Business ) Monthly
Revenue J$ Expenses J$
Sale Purchase
    Rent
    Telephone
    Water
    Electricity
    Transportation
    Wages:  Proprietor
    Employees
    Other
Total Business Revenue Total Business Expenses
STATEMENT OF REVENUE & EXPENSES (HOUSEHOLD) MONTHLY
REVENUE J$ Expenses J$
Salary Food
Business Income to Household Schooling
Rental Income Health Care
Remittances Hire Purchase
    Rent/ Mortgage
    Telephone
    Water
    Electricity
    Transportation
    Other
Total Household Revenue Total Household Expenses
CREDIT REFERENCES
Supplier Credit/ Loan/ Hire Purchase   Supplier  Credit/ Loan/ Hire Purchase  
Supplier / Store/ Creditor: Supplier / Store/ Creditor:
Date: Date
Amount Amount
Address Address
Tele No. Tele No.
Comments Comments
Reference By:  
Employer
Work Address:
Home Address:
TRN:
Household/ Utility Payments Current Cash Resources (J$) :
Telephone Bank
Electricity Partner
Water