Hire Purchase Form

APPLICATION FORM

A. CLIENT BIODATA

Title *
First Name *
Middle Name
Surname *
D.O.B *
Mobile Number *
ID Type *
Residential Address *
Proof of Address *
Ghana Post Coordinates
Length of Stay in Current Location *
Postal Address
Marital Status *
Email *
Number of Dependants *

B. PARTNER DETAILS

Full Name of Spouse *
Mobile Number of Spouse

A. RESIDENTIAL REFERENCE

Name of Referee *
Mobile Number *

EMPLOYMENT DETAILS

A. FORMAL

Name of Employer
Role
Number of Years in Organisation
Address of Employer
Postal Address
Postal Address
Phone Number

Business Reference

Name of Referee *

Name of second referee *

Mobile Number *

B. IF INFORMAL

Nature of Business Activity

Business Location Provide Landmarks

Years in Business

INCOME DETAILS

Name of Account, Bank, Branch and Account Number *

ITEM

C. APPLIANCE REQUESTING FOR

Name of Item Requesting For *
Proposed Duration (in months) to Pay For Item *
Source of Monthly Repayment *
Payment Type *

FINANCING AGREEMENT

Initial Deposit Agreement *
Upload Your Bank Statement/ Payslip *
Upload Your ID *

CLIENT'S DECLARATION

CLIENTS INITIALS

SIGN YOUR INITIALS BELOW TO AGREE TO THE ABOVE DECLARATION *I declare that the above information to the best of my knowledge. In support of my application, i understand that if any of the information I have provided proves to be false, it will lead to the automatic decline of my request. If it is found out that any of the information I have provided proves to be false after delivery of item, City Hire Purchase has the right to retrieve the item. I consent to CHP in connection with this application, making such enquiries about my affair as it deems fit I will also be available for further discussions upon request.
Date *

TERMS AND CONDITIONS

Verification

Please enter any two digits *Example: 12
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