Black Stone Finance Limited

New Loan — Long Term Loan Application Form

Personal Information

Loan Detail Form

Authority to Deduct

Loan Details

Purpose of the Loan (Please Specify)*

Amount Applied For (PGK)*

Long Term (Number of Fortnights)*

Personal Information

Given Names*

Surname*

Birth Date*

Birth Village*

District*

Province*

Residential Address*

Mobile Number*

WhatsApp Number

Email (Personal)*

Employment Information

Employer*

Department*

Section*

Position*

Immediate Supervisor*

Phone (Office)*

Email (Office)

Years of Employment with the Organisation*

Bank Details

Bank*

Branch*

Account Number*

Account Name*

Account Type*

SavingsChequeOthers

Borrower Acknowledgement

By Signing,

1. I hereby warrant that all information given in this Application Form are true and I authorise Black Stone Finance Limited to obtain and disclose information about me from and to any reference source for credit reporting, verification and other risk management requirements.

2. I hereby warrant that all information given in this Application Form are true and correct and that all information supplied to Black Stone Finance Limited have in no way been falsified to assist processing and approval of my application for loan.

3. My bank account shall be used by the Lender / Black Stone Finance Limited to credit the proceeds of this loan.

4. I acknowledge that I have carefully read and understood the contents of this Loan Agreement between myself and Black Stone Finance Limited and agree to abide by its terms and conditions.

5. I acknowledge that I have carefully read and understood the Authority To Deduct Salary Form, Loan Detail Form and other integral parts of this Loan Agreement between myself and Black Stone Finance Limited and agree to abide by their terms and conditions.

6. I shall be responsible on full indemnity basis for all costs incurred by the lender / Black Stone Finance Limited in the preparation, negotiation, recovery (including legal cost and administration of this loan agreement).

Name*

Signature (Type full name)*

Date*

Assignment of Entitlements

I hereby irrevocably assign to Black Stone Finance Limited pursuant to the Mercantile Act (Chapter 260), all my entitlements and/or savings from those entities listed below, in consideration of monies I owe Black Stone Finance Limited.

Finish Pay and EntitlementsNational Superannuation Fund (NASFUND)Public Officers Superannuation Fund (POSF)

Other (Please Specify):

Employee/Borrower Name

Position

Signature (Type full name)

Date

Office Use: Form Fully Completed & Checked. Sign: __________________________________ Processing Officer — Black Stone Finance Limited