Existing Good Payers Customer Application - 3MIF - Courts Fiji

CUSTOMER DETAILS

Customer ID or Account No *

Check the appropriate option*

Joint with Spouse
Sole
Business (Sole Trader/Partnership/Private)
Joint with Other/Several

New Customer Details

Requested Limit *

Term

Maximum 3 months

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Date of Birth *

Gender *

Age

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Title *

First Name *

Middle Name *

Last Name *

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Email Address *

Mobile No *

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FNPF No *

Customer TIN *

0 of 12 max characters.

Drivers License or Voter ID *

PERSONAL DETAILS

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Father’s Name *

First

Last

Mother’s Name *

First

Last

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Father's Original Village Name

Mother's Original Village Name

Marital Status

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No of Children

No of Dependents

Ethnic Group *

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Business Name

Business Reg No

Vehicle Details

Vehicle Type

Vehicle Registration No

Bank Details

Bankers Name

Bank Account No *

RESIDENTIAL STATUS

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Home Address Line 1

Home Address Line 2

Contact Details

Landline *

Mobile *

Current Address Since

Property Type *

Previous Address Since

End Date

Reason

Delivery Address

Delivery Address Details

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P.O.Box

Other

EMPLOYMENT DETAILS

Employer details

Employer

Employer Industry

Status

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Occupation

No of Years/Months

Pay Frequency

Pay Amount

Annual Gross

Annual Net After Tax

Current Employment Start Date

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Previous Employment Start Date

End Date

Reason

FINANCIAL STATUS

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Monthly Net Income After Tax *

Additional Income *

Source of Additional Income *

Total *

Utility Bill Details

Utility Bills *

Utility Bill Breakdown *

Living Expenses Details

Living Expenses *

Living Expenses Breakdown *

Bank/Creditor Loans Details

Bank/Creditor Loans *

Bank/Creditor Loans Breakdown *

EMPLOYMENT DETAILS

Address Details

Address 1

Address 2

Address 3

Other Employee Details

Telephone No

Mobile No

Department Details

Department

Staff/Employment No

Date

Existing Good Payers Customer Application – 3MIF