Applicant

• Surname
• First name
• Gender
  -MaleFemale
• Date of birth (dd/mm/yyyy)
• Place of birth
• Smoker
  -NoYes
• Marital status
  -SingleMarriedLegal PartnerPartnerDivorcedWidowedSeparated
• If married, what agreement
  -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
• Number of dependent children
  -01234566+
• Age of children
• Address and no.
• Postal code
• Town
• From what date have you lived here?
• Telephone (home)
• Telephone (mobile)
• Office telephone no.
• If less than 2 years, please give the previous address (street, no., postal code, town)
• Email
• Are you a Test-Achats member?
  -NoYes
• If yes, please state your membership number
• Are you already a VDV CONSEIL client?
  -NoYes

Applicant

• Occupational status
  -Blue-collar workerWhite-collar workerSelf-employedState employeeServiceman or womanDisabled personUnemployedRetired
• Recruitment date
• Type of contract
  -Open-endedFixed-termAppointed
• Name of employer
• Employer's address
• Employer's telephone no.
• Monthly income nets
• Lunch vouchers or other benefits
• Unemployment benefit
• Other income (please specify)
• Welfare and child benefits
• Current rental income
• Future rental income

Applicant

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

Applicant

• Total expenses (Rent not included)
• Your rent

• Have you had financial problems? If yes, when? With which institution? ...Explain briefly:

• Anticipated project date
• Desired rate formula
  -Variable YearlyVariable 5/5/5Semi-fixed 15/5Fixed
• Desired loan period (in years)

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 on developments and promotions at VDV Conseil.