Origenes Del Codigo Civil Dominicano

DL FINANCIAL II{VESTMENT TRADING LTD

Business & Project Loan Application Form
carefullyEothrouhthe appliction form
and

fillit cotr€tV

Section 1 Company lnformation
Business Type
Public company
Pa

E
fl

lncorporäted Company

E
fl

sole Träder

E
fl

rtnership

Union/Foundation

lndividual

Company Registration No

Tax lD No

Registered Business Nameof Applicant Registered Business Address of Applicant

Country of lncorporation

Year of lncorporation

SECTION 2 -APPLICANT IDENTIFICATION INFORMATION AND INDIVIDUAL DETAILS

ldentifi cation intormation
To

complywith our obligations under the Anti-Money Laundering and counteFTerrorism Financing Act (2005), we must collect certain information in relationtoyou.
Theinformationto be collected depends upon on which type ofapplicantyou are as follows: ifyou are an individual(s), details ofeach individual; ifyou are a company, details ofeach director; ifyou are a partnership, detaik of each partner; ifyou are an incorporated association, details ofthe associationt Chairman, Secretary and Treasurer (or equivalent officer in each case); ifyou are a union, detaikofthe union s Chairman, Secretary and Treasurer (or equivalent officer in each case).

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DI, FINANCIAI, INVF^STMFNT TRADING I,TI)

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Title
First Name
Last Name

(Mr, Mrs, Miss, Ms, Dr or specifu)

Middle Name
Date of Birth

Country of Birth

Nationality

Company Name
Designation
Contact Address

Telephone
Fax

Mobile
Email Type of ldentification

fl

tnternational Passport

f

l oriver's

License

I

lNational lD card

lD No

Country of lssue

(copy of lD is required for application processint)

lnvestment Loan
Loan Amount

Trade Loan

Project Development Loan

(S€r)
6 Months 12 Month
18 Months

Duration

24 Months

Others

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DI, FINANCIAI, INVF^STMFNT TRADING I,TD

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Purpose ofLoan
Pleas€ ghre a5 much details as possible, thiswill help in the processing and

approval of your

applkation. we may reguire a bu5ine55 plan or
f€äsibility study on your propos€d us€ of th€ loan for evaluation purpos€s.

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DI, FINANCIAI, INVESTMFNT TRADING I,TI)

Terms and Release Statement
IMPORTANT: Read thoroughly before signing.

1. Are you reläted 2.

to anyDrrector or Employee of DL Frnänoäl lnvestment T€drng Ltd

?

vrsfl

ruof l

Areyou or any closely related individual orcompany involved in any legal action or litigation either personally orthrough your business?

vrsn lo n
YES

3. lf your application is approved will you allow DL Financial lnvestment Träding Ltd to m ake a public announcem ent regarding your businessruofl

The statements made herein are for the express purpose of obtaining financing from DL Financial lnvestment Trading Ltd and are to the best of mylour knowledge and belieftrue and correct. The applicant understands that additional information, if required in support ofthis applicatiory must be supplied to the DL Financial lnvestm ent Trading Ltd beforeadequate consideration canbegiven to this applicant. The applicant consents to DLFinancial lnvestm ent Trading Ltd making any enquiries ofsuch persons,firms orcorporätions, as it deems necessary in orderto reach a decision on this application. The applicant agrees to reimburse DL Financial lnvestment Träding ttd any legal costs incurred in the registration ofdocuments for loan security. shouldthe applicant withdräw hisrequestforfunds after legal documents have been registered and cost incurred, the applicant shallbe responsible

l, hereby agree that iffinancing is provided to me, for the purpose

ofthe business project described herein, that:

. .

lshalltollowthe operation plan to be submitted. lshallusethetunds receivedtrom DL Financial lnvestment Trading Ltd tor the pu rposes intended....