• Specify the purpose (improvements, credit consolidation, purchase of lounge suite, etc.)
• Required amount
• Required term
  -243036424860728496108120

If purchasing a consumer good, please specify the following details:

• Description of good
• Purchase price
• Seller's name
• Seller's address & tel. no.

Applicant

• Surname
• First name
• Gender
  -MaleFemale
• Date of birth (jj/mm/aaa)
• Place of birth
• Smokers habits
  -Non smokersmoker
• Marital status
  -SingleMarriedDivorcedWidowedSeparated
• If married, what matrimonial property regime
  -Community of propertyGeneral community of propertySeparation of property
• Nationality
• If foreign national,from what date have you been in Belgium?
• Identity card no. Invalid card number (Belgian format)
• + dates of validity
• National register no. Invalid card number (Belgian format)
• Number of dependent children
  -01234566+

• Address and no.
• Postal code
• Town
• From what date have you lived here?
• If less than 2 years, please give the previous address (street, no., postal code, town)
• Email

Applicant

• Occupational status
  -Blue-collar workerWhite-collar workerSelf-employedState employeeServiceman or womanDisabled personUnemployed
• Recruitment date
• Type of contract
  -Open-endedFixed-term
• Name of employer
• Employer's address
• Employer's telephone no.
• Net monthly income
• Lunch vouchers or other benefits
• Unemployment benefit
• Other income (please specify)
• Welfare and child benefits, pensions etc.
• Current rental income
• Future rental income
• Your bank account number

Applicant

• Surname & First Name / Legal form
• Start date of business
• Nature of business
• Taxable income since last assessment notice
• VAT No.
• Trade Register No.

Applicant

• Alimony payable
• If tenant, rent amount

If owner, please specify the following details:

• Start of mortgage loan (dd/mm/aaaa)
• Amount
• Term (in months)
• Monthly payment
• Credit institution

Applicant

• Explanation if no accommodation expenses:

• Have you had financial problems? If yes, when? With which institution? ...Explain briefly:
• Have you already applied for one or more loans recently? If yes, when? With which institution? What was the outcome of the application(s)? ...Explain briefly

Comments if any:

• This information is given on a confidential basis; you may however authorise us to use your e-mail address to be kept informed of developments and promotions at VDV Conseil.