Private Individual
Legal Entity
Name of the Company
Legal Form
Legal Address
Actual Address
Identification Code
Information About Contact Person
Position
First Name
Last Name
Personal Number/ID
Email
Legal Address
Actual Address
Mobile Number
Home Phone
CitizenShip
Date of birth
June 2001
Sun
Mon
Tue
Wed
Thu
Fri
Sat
22
27
28
29
30
31
1
2
23
3
4
5
6
7
8
9
24
10
11
12
13
14
15
16
25
17
18
19
20
21
22
23
26
24
25
26
27
28
29
30
27
1
2
3
4
5
6
7
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Loan Amount
Currency
Maturity
Loan Purpose
Repayment Schedule
Loan Information
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Information About Client's Income
Income From Business
Activity
Monthly Income
GEL
USD
EUR
Income
Work Place
Position
Salary
Bank
GEL
USD
EUR
Procredit Bank
TBC Bank
Bank Of Georgia
Liberty Bank
VTB Bank
Basis Bank
Kor Standard Bank
Repoblic Bank
Cartu Bank
Other
Rental Income
Commercial
Dwelling House
Income Per Month
GEL
USD
EUR
Information About Current Obligation
Installment Per Month
GEL
USD
EUR
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The Borrower expresses its consent to JSC ProCredit Bank to process his/her banking and personal information, as well as to verify information in the database of JSC CreditInfo Georgia for the purpose of considering this application/rendering any banking service.