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Credit request form

General Data
Credit loan amount	€	(Alleen hele bedragen)
Spending aim
Type of house		Bought houseTenement houseResident
Rent benefit		YesNo
Bald month hiring	€	(without gas/water/light)
Applicant Data
Name		Initials Insertions Surname MrMs
Date of birth		12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 19951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913
Nationality		DutchDifferent
Streetname
House number
House number addition		(e.g. 1 High)
Postal number
Place of residence
Living since		12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 20132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913
Telephone number
Mobile number
E-mail
Number of bank account
The income of the applicant
The source of income		Paid employmentBenefit/pensionIndependent entrepreneurNone
Operative since		12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 20132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913 (At current employer)
Employment contract		Job from an employment agencyTemporarily tenureFixed tenure for an unknown time
Profession
Gross income	€	per monthper 4 weeksper week
Net income	€	per monthper 4 weeksper week
Gross year income	€
Employer
Residence of the employer
Other income		Paid employmentBenefit/pensionIndependent entrepreneurNone
Domestic situation
I am		MarriedSingleCohabiting
There are		none123456 home living children under the age of 18
Current credit loans data:
There are none123456 current credit loans.
Are there irregular payments or payment delays known at the BKR: Yes No
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