Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697642570991.pdf (Bahamas)
BAHAMAS DEVELOPMENT BANK Form 11101 (10/2013) PERSONAL STATEMENT OF AFFAIRS NAME (PLEASE PRINT) DATE OF BIRTH (YYYY/MM/DD) AGE MARTIAL STATUS NO.

OF DEPENDENTS PERSONAL INFORMATION NATIONAL INSURANCE NO./NATIONAL I.D.

: DRIVER’S LICENSE NO.

: EXPIRY DATE (YYYY/MM/DD): PASSPORT NO.


: EXPIRY DATE (YYYY/MM/DD): HOME ADDRESS – NUMBER, STREET, CITY POSTAL BOX SINCE (YEAR) TELEPHONE NUMBERS SPOUSE’S NAME DATE OF BIRTH (YYYY/MM/DD) Home: Cell: Work: NAME, ADDRESS & CONTACT OF LANDLORD (IF RENTING) PREVIOUS ADDRESS YEARS THERE NEXT OF KIN ADDRESS – STREET, CITY, P.O.

BOX TELEPHONE NUMBERS RELATIONSHIP Home: Work: Cell: NEXT OF KIN ADDRESS – STREET, CITY, P.O.
BOX TELEPHONE NUMBERS RELATIONSHIP Home: Work: Cell: NAME OF BANK OR FINANCIAL INSTITUTION HAVE YOU ANY JUDGEMENTS OR LEGAL PROCEEDINGS AGAINST YOU?

YES NO IF YES, SEE PAGE 2 FOR DETAILS  INDIRECT LIABILITIES (GUARANTEES OR ENDORSEMENTS FOR OTHERS) YES NO HAVE YOU EVER BORROWED BEFORE FROM ANY SOURCE?

YES NO NAME & ADDRESS OF EMPLOYER IF YES, WHERE AND WHEN AMOUNT HAVE YOU HAD ANY PREVIOUS LOANS FROM THE BDB?
IF YES, WHERE AND WHEN AMOUNT YES NO EMPLOYMENT INFORMATION TELEPHONE EMPLOYMENT DATE (YYYY/MM/DD) PRESENT ANNUAL SALARY OR WAGES ($) OCCUPATION POSITION RENTAL INCOME: 50% 75% PREVIOUS EMPLOYER EMPLOYMENT DATE (YYYY/MM/DD) OTHER INCOME (SOURCE) NAME & ADDRESS OF SPOUSE’S EMPLOYER TELEPHONE EMPLOYMENT DATE (YYYY/MM/DD) SPOUSE’S ANNUAL SALARY OR WAGES ($) OCCUPATION POSITION TOTAL ANNUAL INCOME PREVIOUS EMPLOYER EMPLOYMENT DATE (YYYY/MM/DD) TOTAL MONTHLY INCOME ® Registered trademark of Bahamas Development Bank.
Page 1 of 2 ASSET AMOUNT LIABILITIES AMOUNT MONTHLY PMT FINANCIAL INFORMATION CASH CASH (OTHER) (LOANS, MORTGAGES, CREDIT CARDS.

ALL OTHER DEBTS) MORTGAGE RENEWAL DATE (YYYY/MM/DD) LIQUID INVESTMENTS (STOCKS, BONDS, ETC.)
BANK LOANS – (BDB) LIFE INSURANCE – FACE AMOUNT PAYABLE TO BANK LOANS – OTHER LOANS – (CREDIT UNION, OTHER) LOANS – INSURANCE CO. csv OTHER LIQUID ASSETS (SPECIFY) CREDIT CARDS – VISA – LIMIT $ REAL ESTATE AUTOMOBILE YEAR AND MAKE YEAR AND MAKE FURNITURE OTHER OTHER OTHER CREDIT CARDS – OTHER – LIMIT $ OTHER DEBTS (SPECIFY) MONTHLY RENT (IF APPLICABLE) SUBTOTAL SURPLUS TOTAL  TOTAL  REAL ESTATE OWNED - LOCATION REGISTERED - OWNER YR PURCHASED PURCHASE PRICE VALUE EQUITY FIRE INS I/We, the undersigned, do hereby affirm that the information contained in this application form (to the best of my/our knowledge) is true and correct.
I/We also authorize the Bahamas Development Bank (including its officers, employees and agents) to carry out such investigation it deems necessary to verify information supplied herein.

I/We also request and authorize all companies (including but not limited to all commercial banks and other financial institutions) contacted by the Bahamas Development Bank, its agents or representatives, to release all information requested that concerns me/us.
I/We hereby acknowledge and agree that companies releasing information to the Bahamas Development Bank shall bear absolutely no responsibility or liability for any loss emerging from the disclosure and/or use of such information provided to the Bahamas Development Bank.

APPLICANT’S SIGNATURE CO-SIGNOR (SPOUSE ONLY) WITNESS DATE: ® Registered trademark of Bahamas Development Bank.

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