• (758) 451-5622
  • st.lucia@capitacaribbean.com
Financial Wellness Center
  • (758) 451-5622
  • st.lucia@capitacaribbean.com
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Customer Application Form

Today. Tomorrow. Together

Customer Application Form

Name
Are you an existing client of CAPITA
Are you a member of BPWCCUL
Are you a Political Exposed Person (PEP)
PEP means a politically exposed person i.e. an individual or immediate family member who is or has been entrusted with a prominent public position or function, or a person known to be a close associate of such a person.
General Information
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Prefix
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CONTACT DETAILS
(Proof of address must be submitted. No P.O. Boxes allowed)
Do you:
(If different from residential address)
(Only required if residing at the above address for less than 2 years)
EMPLOYMENT DETAILS
Pay Mode:
Employment Status:
REFERENCES
STATEMENT OF ASSETS AND LIABILITIES
DISCLAIMER CLAUSE The Applicant (s) hereby warrants that the information herein provided is true and correct and I/we have disclosed all information relevant to the determination of my/our credit responsibility or creditworthiness. Capita Financial Services Inc. (the Company) is hereby authorized to disclose the above and/or any information concerning this or any previous application obtained in the normal course of business to any credit reporting agency, financial institution or agent acting on the Company’s behalf. The Company is also authorized to retain the application whether or not the relative loan is approved. The applicant(s) also authorizes the Company to disclose information to any branch of Capita Financial Services Inc. or associated companies in Barbados, St Lucia or any other country. The Company reserves the right to request updated/additional information as they may require. The Applicant (s) by his/her/their signature hereto authorizes the release by the Company to any third party of any information and/or records concerning the undersigned.
Clear Signature
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