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PERMOHONAN PEMBIAYAAN

Identitas Pemohon Baru Rolling


1. Nama : ...............................................................................................................
2. No.KTP/masa berlaku : ...............................................................................................................
3. Tempat, tanggal lahir : ...............................................................................................................
4. Pekerjaan : ...............................................................................................................
5. Nama (suami/istri) : ...............................................................................................................
6. KTP/masa berlaku : ...............................................................................................................
7. Pekerjaan (suami/istri) : ...............................................................................................................
8. Alamat : ...............................................................................................................
...............................................................................................................
9. Alamat tempat tinggal : ...............................................................................................................
..............................................................................................................
Kontrak/sewa sendiri
10. Izin usaha : ..............................................................................................................
Ada Tidak
11. Lokasi usaha : ...............................................................................................................
12. Jumlah tanggungan : ...............................................................................................................
13. Telp/HP : ...............................................................................................................
Data Pembiayaan
1. Tujuan Pembiayaan : ...............................................................................................................
2. Plafond : Rp. ........................................................................................................
3. Jangka waktu : ..............................Bulan/tahun.............................................................
4. Keuntungan BMT : ................................... Angsuran Rp. .....................................................
5. Sistem Pengembalian : harian mingguan bulanan tahunan
6. Bentuk Pembiayaan : ...............................................................................................................
Ba’i Bitsaman Ajil Murabahah Ijarah
Mudharabah Musyarakah Al Qardhul Hasan
Data Jaminan
Jaminan Tahun Harga pasar

Sumber Penghasilan : ...............................................................................................................


...............................................................................................................
Kelengkapan Pembiayaan
KTP Pemohon Slip Gaji KTP Penjamin
KTP Suami/Istri Denah Tempat Tinggal Fotocopy Surat Nikah
C1 Denah Tempat Usaha ........................................
Fotocopy Jaminan Denah Jaminan ........................................
Keterangan
Tanggal Pemohon Suami/istri Penerima Cek.Manager Ket. pengurus

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