Mortgage Application Form

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Kindly Provide Us With The Following Information

I /WE HEREBY WARRANT AND CONFIRM THAT ALL STATEMENTS MADE HEREIN OR IN ANY ATTACHMENTS HERETO ARE TRUE AND CORRECT AND HAVE BEEN MADE BY ME KNOWING YOU WILL RELY THEREON IN CONSIDERING THIS APPLICATION FOR FACILITIES. I/WE AUTHORISE REPUBLIC BANK LIMITED TO OBTAIN FURTHER INFORMATION ON MY/OUR CREDIT HISTORY AND ANY SUCH SOURCE IS HEREBY AUTHORISED TO PROVIDE THE REQUESTED INFORMATION. REPUBLIC BANK LIMITED IS ALSO AUTHORISED TO DISCLOSE TO ANY CREDIT BUREAU AND OTHER CREDIT GRANTORS ANY INFORMATION ABOUT MY/OUR CREDIT HISTORY. I/WE AGREE TO JOINTLY AND SEVERALLY INDEMNIFY REPUBLIC BANK LIMITED AGAINST ANY AND ALL CLAIMS IN DAMAGES OR OTHERWISE ARISING FROM SUCH DISCLOSURE ON ITS PART.

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