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Financial Hardship Application
Account Number / Vehicle Reg.
Account Name
Date
Residential Address
Postal Address
Email
Telephone
Mobile
Why are you applying for financial hardship assistance? (Tick which is applicable)
Loss of employment
Experience a reduction in income
Suffering an illness or major injury
Other significant event that has affected my income. Please provide details
ID (Passport copy / Driver's License or Joint TIN Card)
Proof of unemployment/reduced hours/reduced pay from employer
Proof of medical illness/injury
Evidence of additional income (i.e. rental income, benefits, boarder income)
Last 3 months’ statements for all bank accounts
Last 6 months’ statements for any loans with other banks, finance companies or stores (i.e. credit cards, personal loans, hire purchases
Repayment arrangements with other Financial Institutions
Evidence that insurances are paid and up to date
I/We hereby declare that the information in this application and all attachments for financial hardship assistance is true and accurate and Merchant Finance Pte Limited is authorized to carry out any further checks.
Yes
Upload E Signature
Signature Date
Financial Details
Applicant 1
Applicant 2
Other Income
Total Monthly Earnings
Less Monthly Living Costs
Rent
Electricity
Telephone
Water
Housekeeping
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info@mfl.com.fj
+679 331 4955
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