Proposal_Ref_No

Sales Person

Direct Dial

Fax No.

Email:esales@ukcars.ie
APPLICANT VEHICLE

Title

Mr. Mrs. Ms. Dr.

Surname

First name

Address

 

Time at Address

Yrs. mths.    Mother's maiden name

 

Previous address (if less than 3 years at current address)

Time at previous address

Yrs. mths.     Residential status  Home Owner Tenant Living with Parents

Date of birth

Gender Male Female

Place of birth

(as per driving licence/passport)

Telephone

work home

 

mobile email

Marital status

No. of dependent children Occupation

Employment status
(please fill both A and B)

A) Full time Part time Self employed B) Permanent Temporary Contract

Work Permit no.

Work Permit expiry date

Employer name

Employer address

Employer tel. no.

  Time with employer Yrs. mths.

Previous employer name (if less than 3 years with current employer)

  Time with employer Yrs. mths.

Net salary €

per month     Other income € per month

Mortgage/Rent payment €

per month     Other borrowings € per month

Other Information type below

Name of bank

Bank sort code

Bank Account Number

Branch

Time with branch

Yrs. mths.

Joint Proposal (where applicable)

Surname

First name

Please provide Joint Applicant details on separate Proposal Form, which must be signed by the Joint Applicant

Data Protection and Consents. During the course of this application the information that you provide will be forwarded to one or more
financial institution(s), being members of the Irish Finance Houses Association, and used for the purpose of offering you a product or quote.
When considering a request, proposal or application for credit from you, a credit search may be made with one or more credit reference
agencies, including the Irish Credit Bureau (ICB), which will record the making of such search. Furthermore details of any agreement you
enter into, and how you conduct same, will be given to credit reference agencies including the ICB. A search may be carried out to verify
your identity. Credit scoring and other automated decision-making systems may be used.

I confirm my consent to process this application and that the details recorded are correct. I acknowledge that the financial institutions and/or
the ICB and other credit reference agencies are permitted to disclose any material misstatement of fact contained in this proposal to its
members and relevant bodies. I consent to any such application information being processed, recorded and retained by the ICB and other
credit reference agencies.

To digitally sign this form,tick

Enter your name here Date and click on

Year of Registration

Make

Model

Specification

New Used Demo

Current mileage
or


Current kilometres

Cash Price
€  

Less customer deposit
€  

Less trade-in
€  

Plus settlement figure
€  

Finance amount
€  

Term mths.

No. in advance

Customer final payment
€  

Dealer buyback
€  

Finance product required

Hire Purchase

Consumer hire/Lease

Lease

The financial institutions may contact you in relation to other products and services.

Please tick the box if you do not wish to be contacted.

N.B. The applicant will be required
to provide the financial institution
with evidence of identity and
current permanent address in
compliance with the provisions of
the Criminal Justice Act, 1994.