SECONDARY APPLICANT
PERSONAL INFORMATION
Relationship to primary applicant
ID type ID number
Mr. Mrs. Ms. Miss
Last name First name Middle name(s) Maiden name
Birth date Mother’s maiden name (for security purposes) Social Insurance Number
Married Unmarried Separated/Divorced Widowed No. of dependents Ages
Bermudian Yes No Nationality Work Permit holder Yes No Date moved to Bermuda
Relation to Butterfield Customer Employee/Director
ADDRESS
Home address Parish Postal code
Mailing address (if different from above) Time at present address (yrs)
Previous address Time at previous address (yrs)
E-mail address Home telephone Cellular number
Residence Rent Own Own free & clear Live with relatives
Name and phone number of mortgage holder or Landlord
EMPLOYMENT
Name of present employer Occupation Years of employment Work telephone
Previous employer Years of employment
Do you have any outstanding debts with Bermuda Credit Association? Yes No
If yes, give details
Do you have any outstanding judgements or are you a defendant in any suits or legal action? Yes No
If yes, give details
Do you have any obligations as an endorser, co-maker or guarantor? Yes No
If yes, give details
I am also interested in: Credit Cards Savings accounts Chequing accounts Insurance Other (please state)
I/We hereby declare that the information which I/we have arranged to provide to you in support of this application is true and complete in all material respects and that no
information is omitted in relation to any of the items describing my/our liabilities.
I/We authorise you to contact such persons as you think fit to verify the correctness and completeness of this information and authorise any such persons to release it to you.
Kindly debit $ from my/our account I/N/O commencing on and on the day of the month on a
monthly / quarterly / annual / other: basis. This authority is to remain in effect until cancelled in writing by me/us. In the event my/our primary
account has insufficient funds to cover my/our loan payments, I/we hereby give authorisation for the Bank to debit any other joint account with the same signatory requirements
or any individual account in any of our names to cover the monthly commitment.
Signature of primary applicant Date Signature of secondary applicant Date
Butterfield Mortgage and Loan Application
The Bank of N.T. Butterfield & Son Limited
( ) ( )
( )
FOR BANK USE ONLY
CIF no.
FLL application no.
DD / MM / YY
DD / MM / YY
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