Hire Purchase Form APPLICATION FORMA. CLIENT BIODATAFirst Name *Title *MrMrsDrProfMiddle Name Surname *Date of Birth *Mobile Number *ID Type *PassportVoters IDSSNITDrivers LicenseResidential Address *Proof of Address *Utility BillTenancy AgreementLand TitleGhana Post Coordinates *Length of Stay in Current Location *Postal Address Marital Status *MarriedSingleDivorcedWidowedSeperatedEmail *Number of Dependants * B. PARTNER DETAILSFull Name of Spouse *Mobile Number of Spouse *A. RESIDENTIAL REFERENCEName of Referee *Mobile Number * EMPLOYMENT DETAILSA. FORMALName of Employer *Role *Number of Years in Organisation *Address of Employer *Postal Address Phone Number Business ReferenceName of Referee *Mobile Number *Name of second referee *Mobile Number *B. IF INFORMALNature of Business Activity Business Location Provide Landmarks Years in Business INCOME DETAILSName on Account *Bank Branch *Account Number ITEMC. APPLIANCE REQUESTING FORName of Item Requesting For *Proposed Duration (in months) to Pay For Item *Source of Monthly Repayment *Payment Type *Mobile MoneyChequesCash FINANCING AGREEMENTInitial Deposit Agreement *Upload Your Bank Statement/ Payslip *Upload Your ID * CLIENT'S DECLARATIONCLIENTS INITIALSSocial Media Handle (Facebook | LinkedIn | Instagram) 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 VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: