‫اﺳﺘﻤﺎرة اﻟﻘﺮض‬ ‫)‪The Commercial Bank (P.S.Q.C.

‬‬
‫‪PO Box 3232, Doha, State of Qatar‬‬
‫‪Tel: +974 4449 0000‬‬
‫اﻟﺒﻨﻚ اﻟﺘﺠﺎري )ش‪.‬م‪.‬ع‪.‬ق‪(.‬‬

‫‪Loan Application Form‬‬ ‫‪Fax: +974 4449 0070‬‬

‫‪www.cbq.qa‬‬

‫)‪Personal Details (Applicant 1‬‬ ‫اﻟﺒﻴﺎﻧﺎت اﻟﺸﺨﺼﻴﺔ )ﻣﻘﺪم اﻟﻄﻠﺐ (‬

‫‪Name as in QID/Passport‬‬ ‫اﻻﺳﻢ ﻛﻤﺎ ﻓﻲ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﻘﻄﺮﻳﺔ‪/‬ﺟﻮاز اﻟﺴﻔﺮ‬
‫اﺳﻢ اﻟﻌﻤﻴﻞ‬
‫‪Client Name CHAU MINH‬‬ ‫‪KY‬‬
‫اﻟﺠﻨﺴﻴﺔ‬ ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬ ‫اﻟﺠﻨﺲ‬ ‫ذﻛﺮ‬ ‫أﻧﺜﻰ‬
‫‪Nationality VIET NAM‬‬ ‫‪Date of birth‬‬ ‫‪1301984‬‬ ‫‪Gender‬‬ ‫‪Male‬‬ ‫‪Female‬‬
‫رﻗﻢ اﻟﺤﺴﺎب اﻟﺮﺋﻴﺴﻲ‬ ‫رﻗﻢ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﻘﻄﺮﻳﺔ اﻟﺴﺎرﻳﺔ‬
‫‪Primary account no.‬‬ ‫‪331456404‬‬ ‫‪Valid QID number‬‬ ‫‪28470400829‬‬

‫)‪Contact Details (Applicant 1‬‬ ‫ﺑﻴﺎﻧﺎت اﻻﺗﺼﺎل )ﻣﻘﺪم اﻟﻄﻠﺐ (‬

‫اﻟﻤﺪﻳﻨﺔ‬
‫‪City‬‬ ‫‪WAKRA CITY‬‬
‫اﻟﺠﻮال‬ ‫اﻟﻤﻨﺰل‬
‫‪Mobile‬‬
‫‪+‬‬ ‫‪9‬‬ ‫‪7‬‬ ‫‪4 30283834‬‬ ‫‪Home‬‬
‫‪+ 9 7 4‬‬
‫اﻟﻤﻜﺘﺐ‬ ‫اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬
‫‪Office‬‬
‫‪+‬‬ ‫‪9‬‬ ‫‪7‬‬ ‫‪4‬‬ ‫‪Email address‬‬ ‫‪minhky032003@gmail.com‬‬

‫)‪Address Details (Applicant 1‬‬ ‫ﺗﻔﺎﺻﻴﻞ اﻟﻌﻨﻮان )ﻣﻘﺪم اﻟﻄﻠﺐ (‬

‫ﺻﻨﺪوق اﻟﺒﺮﻳﺪ‬ ‫اﻟﻤﺪﻳﻨﺔ‬
‫‪P.O. Box‬‬ ‫‪City‬‬
‫ﻋﻨﻮان اﻹﻗﺎﻣﺔ‬ ‫رﻗﻢ اﻟﺸﺎرع‬ ‫اﻟﻤﻨﻄﻘﺔ‬ ‫رﻗﻢ اﻟﻤﺒﻨﻰ‬ ‫رﻗﻢ اﻟﻤﻨﻄﻘﺔ‬ ‫اﻟﺒﻠﺪ‬
‫‪Residential address‬‬ ‫‪Street‬‬ ‫‪667‬‬ ‫‪Area‬‬ ‫‪Building No‬‬ ‫‪27‬‬ ‫‪Zone‬‬ ‫‪90‬‬ ‫‪Country‬‬

‫)‪Personal Details (Applicant 2‬‬ ‫اﻟﺒﻴﺎﻧﺎت اﻟﺸﺨﺼﻴﺔ )ﻣﻘﺪم اﻟﻄﻠﺐ ‚(‬

‫‪Name as in QID/Passport‬‬ ‫اﻻﺳﻢ ﻛﻤﺎ ﻓﻲ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﻘﻄﺮﻳﺔ‪/‬ﺟﻮاز اﻟﺴﻔﺮ‬
‫اﺳﻢ اﻟﻌﻤﻴﻞ‬
‫‪Client Name‬‬
‫اﻟﺠﻨﺴﻴﺔ‬ ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬ ‫اﻟﺠﻨﺲ‬ ‫ذﻛﺮ‬ ‫أﻧﺜﻰ‬
‫‪Nationality‬‬ ‫‪Date of birth‬‬ ‫‪Gender‬‬ ‫‪Male‬‬ ‫‪Female‬‬
‫رﻗﻢ اﻟﺤﺴﺎب اﻟﺮﺋﻴﺴﻲ‬ ‫رﻗﻢ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﻘﻄﺮﻳﺔ اﻟﺴﺎرﻳﺔ‬
‫‪Primary account no.‬‬ ‫‪Valid QID number‬‬

‫)‪Contact Details (Applicant 2‬‬ ‫ﺑﻴﺎﻧﺎت اﻻﺗﺼﺎل )ﻣﻘﺪم اﻟﻄﻠﺐ ‚(‬

‫اﻟﻤﺪﻳﻨﺔ‬
‫‪City‬‬
‫اﻟﺠﻮال‬ ‫اﻟﻤﻨﺰل‬
‫‪Mobile‬‬ ‫‪9‬‬ ‫‪7‬‬ ‫‪4‬‬ ‫‪Home‬‬ ‫‪9‬‬ ‫‪7‬‬ ‫‪4‬‬
‫‪+‬‬ ‫‪+‬‬
‫اﻟﻤﻜﺘﺐ‬ ‫اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬
‫‪Office‬‬ ‫‪9‬‬ ‫‪7‬‬ ‫‪4‬‬ ‫‪Email address‬‬
‫‪+‬‬

‫)‪Address Details (Applicant 2‬‬ ‫ﺗﻔﺎﺻﻴﻞ اﻟﻌﻨﻮان )ﻣﻘﺪم اﻟﻄﻠﺐ ‚(‬

‫ﺻﻨﺪوق اﻟﺒﺮﻳﺪ‬ ‫اﻟﻤﺪﻳﻨﺔ‬
‫‪P.O. Box‬‬ ‫‪City‬‬
‫ﻋﻨﻮان اﻹﻗﺎﻣﺔ‬ ‫رﻗﻢ اﻟﺸﺎرع‬ ‫اﻟﻤﻨﻄﻘﺔ‬ ‫رﻗﻢ اﻟﻤﺒﻨﻰ‬ ‫رﻗﻢ اﻟﻤﻨﻄﻘﺔ‬ ‫اﻟﺒﻠﺪ‬
‫‪Residential address‬‬ ‫‪Street‬‬ ‫‪Area‬‬ ‫‪Building No‬‬ ‫‪Zone‬‬ ‫‪Country‬‬

‫‪Requested Credit Facility‬‬ ‫اﻟﺘﺴﻬﻴﻼت اﻻﺋﺘﻤﺎﻧﻴﺔ اﻟﻤﻄﻠﻮﺑﺔ‬

‫ﻗﺮض ﺷﺨﺼﻲ ﺟﺪﻳﺪ‬ ‫اﻟﺘﻤﻮﻳﻞ اﻹﺿﺎﻓﻲ ﻟﻠﻘﺮض اﻟﺸﺨﺼﻲ‬ ‫ﻗﺮض اﻟﺴﻴﺎرة‬ ‫اﻟﺴﺤﻮﺑﺎت ﻋﻠﻰ اﻟﻤﻜﺸﻮف‬
‫‪New Personal Loan‬‬ ‫‪Top-up Personal Loan‬‬ ‫‪Vehicle Loan‬‬ ‫‪Overdraft‬‬
‫‪19.CB.FRM.210‬‬

‫ﻣﺪة اﻟﻘﺮض اﻟﻤﻄﻠﻮﺑﺔ‪/‬ﺑﺎﻷﺷﻬﺮ‬ ‫ﻣﺒﻠﻎ اﻟﻘﺮض اﻟﻤﻄﻠﻮب‪/‬رﻳﺎل ﻗﻄﺮي‬

‫‪Requested Loan tenor/Month‬‬ ‫‪18‬‬ ‫)‪Requested Loan amount (QAR‬‬ ‫‪15000‬‬
‫ﺗﺎﺑﻊ اﻟﺼﻔﺤﺔ اﻟﺘﺎﻟﻴﺔ‬
‫‪Continue on next page‬‬
Consent and Declaration
I/We the undersigned hereby:
a. Declare that the information provided in this application by me/us
to The Commercial Bank (P.S.Q.C.) (the Bank) is accurate, true and
current, and I /we understand and accept that any facility the Bank
may decide to offer me/us will be on the basis of this information.
The Commercial Bank may, at its sole discretion, withdraw the Loan
application or cancel it at any time if the provided information
is proved inaccurate or untrue or outdated.
b. Acknowledge that the Bank has the sole discretion to approve
or decline my/our application without revealing any reason for its
decision to do so.
c. Authorize the Bank, at any time at its absolute discretion, to use
or disclose the particulars and information provided herein or any
information relating to my/our liabilities towards the Bank or any
other financial information, to banks, debt collection agencies
or credit bureaus.
d. Consent to the Bank obtaining any information which Qatar Credit
Bureau, and/or any other Credit Bureau, duly licensed under the laws
in Qatar (“the Credit Bureau”), may have in regards to me/us each
time I/we request a loan, during the processing or closing of a loan,
or at various times during the term of loan in connection with the
servicing, monitoring, collection or enforcement of the loan.
e. Consent to the Bank advising the Credit Bureau of my/our consent
and/or providing evidence of such consent by electronic or any other
means necessary.
f. Consent to the Credit Bureau providing the said credit information
to the Bank by electronic or any other means necessary.
I/We understand and agree that my/our consent above which
is hereby given:
i. shall subsist for the duration of any current or future facility that
I/we may have or apply for with the Bank and for so long as such
facility shall subsist;
ii. cannot be revoked during the subsistence of any facility that I/we
may have with the Bank but only upon or after the termination of
such facility; and
iii. will be applicable to all applications that I/we may make to obtain
a credit facility from the Bank where I am/we are involved in that
application either as the borrower(s) or guarantor(s) and also for
the purpose of facilitating risk assessment for granting further
extensions of credit by the Bank in relation to any credit facility
currently existing or which may come into existence in the future.
 ‫ﻣﻘﺪم اﻟﻄﻠﺐ‬
Applicant 1
 ‫ﻣﻘﺪم اﻟﻄﻠﺐ‬
Applicant 2
‫اﻟﺘﺎرﻳﺦ‬
Date
‫اﻻﻗﺮار واﻟﻤﻮاﻓﻘﺔ‬
:‫أﻧﺎ أو ﻧﺤﻦ اﻟﻤﻮﻗﻊ أدﻧﺎه‬
(.‫ق‬.‫ع‬.‫م‬.‫ ﻧﻘﺮ ﺑﺄن اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﻀﻤﻨﺔ ﻓﻲ ﻫﺬا اﻟﻄﻠﺐ اﻟﻤﻘﺪم ﻟﻠﺒﻨﻚ اﻟﺘﺠﺎري )ش‬/‫أ( أﻗﺮ‬
‫ﻧﻘﺒﻞ ﺑﺄن أي‬/‫ﻧﺘﻔﻬﻢ وأﻗﺒﻞ‬/ ‫ وأﺗﻔﻬﻢ‬،‫)اﻟﺒﻨﻚ( ﻫﻲ ﻣﻌﻠﻮﻣﺎت دﻗﻴﻘﺔ وﺻﺤﻴﺤﺔ وﺣﺪﻳﺜﺔ‬
.‫ﻟﻨﺎ ﻣﻦ اﻟﺒﻨﻚ اﻟﺘﺠﺎري ﺳﻮف ﺗﻜﻮن ﻋﻠﻰ أﺳﺎس ﻫﺬه اﻟﻤﻌﻠﻮﻣﺎت‬/‫ﺗﺴﻬﻴﻼت ﻣﻘﺪﻣﺔ ﻟﻲ‬
‫ ﺑﺴﺤﺐ ﻃﻠﺐ اﻟﻘﺮض‬،‫ ﻓﻲ أي وﻗﺖ‬،‫ أن ﻳﻘﻮم‬،‫ وﻓﻘﺎ ﻟﺘﻘﺪﻳﺮه اﻟﺨﺎص‬،‫ﻳﺠﻮز ﻟﻠﺒﻨﻚ اﻟﺘﺠﺎري‬
‫ﻗﺒﻠﻨﺎ ﻏﻴﺮ ﻛﺎﻣﻠﺔ‬/‫أو إﺑﻄﺎل ﻣﻌﺎﻣﻠﺔ اﻟﻘﺮض إذا ﺛﺒﺖ ﻟﻪ أن اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﻘﺪﻣﺔ ﻣﻦ ﻗﺒﻠﻲ‬
.‫أو ﻏﻴﺮ ﺻﺤﻴﺤﺔ أو ﻏﻴﺮ ﻣﺤﺪﺛﺔ‬
‫ﻃﻠﺒﻨﺎ‬/‫ﻧﻘﺮ ﺑﺄن اﻟﺒﻨﻚ ﻟﺪﻳﻪ ﺳﻠﻄﺔ ﺗﻘﺪﻳﺮﻳﺔ ﺧﺎﺻﺔ ﻟﻠﻤﻮاﻓﻘﺔ ﻋﻠﻰ أو رﻓﺾ ﻃﻠﺒﻲ‬/ ‫ب( أﻗﺮ‬
.‫دون اﻟﻜﺸﻒ ﻋﻦ أي ﺳﺒﺐ ﻟﻘﺮاره ﺑﺎﻟﻘﻴﺎم ﺑﺬﻟﻚ‬
‫ﻧﻔﻮض اﻟﺒﻨﻚ ﺑﺈن ﻳﻘﻮم ﻓﻲ أي وﻗﺖ وﻓﻘﺎ ﻟﺘﻘﺪﻳﺮه اﻟﺨﺎص ﺑﺎﺳﺘﺨﺪام‬/‫ت( أﻓﻮض‬
‫أو إﻓﺸﺎء اﻟﺘﻔﺎﺻﻴﻞ واﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﻘﺪﻣﺔ ﺑﻤﻮﺟﺐ ﻫﺬا اﻟﻄﻠﺐ أو أي ﻣﻌﻠﻮﻣﺎت ﺗﺘﻌﻠﻖ‬
‫اﻟﺘﺰاﻣﺎﺗﻨﺎ ﺗﺠﺎه اﻟﺒﻨﻚ أو أي ﻣﻌﻠﻮﻣﺎت ﻣﺎﻟﻴﺔ أﺧﺮى ﻷي ﺑﻨﻮك أﺧﺮى أو وﻛﺎﻻت‬/‫ﺑﺎﻟﺘﺰاﻣﺎﺗﻲ‬
.‫ﺗﺤﺼﻴﻞ اﻟﺪﻳﻮن أو ﻣﻜﺎﺗﺐ اﻹﺗﻤﺎن‬
‫ﺑﻨﺎ ﻗﺪ ﺗﻜﻮن‬/‫ﻧﻮاﻓﻖ ﻋﻠﻰ ﻗﻴﺎم اﻟﺒﻨﻚ ﺑﺎﻟﺤﺼﻮل ﻋﻠﻰ أي ﻣﻌﻠﻮﻣﺎت ﺗﺘﻌﻠﻖ ﺑﻲ‬/‫ث( أواﻓﻖ‬
‫ ﻣﺮﺧﺺ ﺣﺴﺐ اﻷﺻﻮل ﺑﻤﻮﺟﺐ‬، ‫ أو أي ﻣﻜﺘﺐ اﺋﺘﻤﺎن آﺧﺮ‬/ ‫ﻟﺪى ﻣﻜﺘﺐ ﻗﻄﺮ اﻻﺋﺘﻤﺎﻧﻲ و‬
‫ ﺧﻼل ﻣﻨﺢ‬، ‫ﻧﻄﻠﺐ ﻓﻴﻬﺎ ﻗﺮﺿًﺎ‬/ ‫ ﻓﻲ ﻛﻞ ﻣﺮة أﻃﻠﺐ‬، ("‫اﻟﻘﻮاﻧﻴﻦ ﻓﻲ ﻗﻄﺮ )"ﻣﻜﺘﺐ اﻻﺋﺘﻤﺎن‬
‫ أو ﻓﻲ أوﻗﺎت ﻣﺨﺘﻠﻔﺔ ﺧﻼل ﻣﺪة اﻟﻘﺮض ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺨﺪﻣﺔ اﻟﻘﺮض‬، ‫اﻟﻘﺮض أو ﺗﺴﻮﻳﺘﻪ‬
.‫أو ﻣﺮاﻗﺒﺘﻪ أو ﺗﺤﺼﻴﻠﻪ أو إﻧﻔﺎذه‬
‫ﻣﻮاﻓﻘﺘﻨﺎ‬/‫ﻧﻮاﻓﻖ ﻋﻠﻰ ﻗﻴﺎم اﻟﺒﻨﻚ ﺑﺈﺑﻼغ ﻣﻜﺘﺐ اﻻﺋﺘﻤﺎن ﺑﻤﻮاﻓﻘﺘﻲ‬/‫ج( أواﻓﻖ‬
‫ أو ﺗﻘﺪﻳﻢ دﻟﻴﻞ ﻋﻠﻰ ﻫﺬه اﻟﻤﻮاﻓﻘﺔ ﻋﻦ ﻃﺮﻳﻖ اﻟﻮﺳﺎﺋﻞ اﻹﻟﻜﺘﺮوﻧﻴﺔ أو ﺑﺄي‬/ ‫و‬
.‫وﺳﻴﻠﺔ أﺧﺮى ﺿﺮورﻳﺔ‬
‫ﻧﻮاﻓﻖ ﻋﻠﻰ ﻗﻴﺎم ﻣﻜﺘﺐ اﻻﺋﺘﻤﺎن ﺑﺘﻮﻓﻴﺮ اﻟﻤﻌﻠﻮﻣﺎت اﻻﺋﺘﻤﺎﻧﻴﺔ اﻟﻤﺬﻛﻮرة‬/‫ح( أواﻓﻖ‬
.‫ﻟﻠﺒﻨﻚ ﻋﻦ ﻃﺮﻳﻖ اﻟﻮﺳﺎﺋﻞ اﻹﻟﻜﺘﺮوﻧﻴﺔ أو ﺑﺄي وﺳﻴﻠﺔ أﺧﺮى ﺿﺮورﻳﺔ‬
:‫ﻣﻮاﻓﻘﺘﻨﺎ أﻋﻼه واﻟﻤﺬﻛﻮرة أدﻧﺎه‬/ ‫ﻧﻘﺮ ﺑﺄن ﻣﻮاﻓﻘﺘﻲ‬/‫أﻗﺮ‬
‫ﻟﻨﺎ أو أﺗﻘﺪم‬/‫ ﺳﺘﻜﻮن ﻣﺴﺘﻤﺮة ﻟﻤﺪة أي ﺗﺴﻬﻴﻼت ﺣﺎﻟﻴﺔ أو ﻣﺴﺘﻘﺒﻠﻴﺔ ﻗﺪ ﺗﻤﻨﺢ ﻟﻲ‬.i
.‫ﻧﺘﻘﺪم ﺑﻄﻠﺐ ﻟﻠﺤﺼﻮل ﻋﻠﻴﻬﺎ ﻣﻦ اﻟﺒﻨﻚ ﻃﺎﻟﻤﺎ ﻇﻠﺖ ﺗﻠﻚ اﻟﺘﺴﻬﻴﻼت ﻗﺎﺋﻤﺔ‬/
‫ﻟﻨﺎ ﻣﻦ ﻗﺒﻞ اﻟﺒﻨﻚ‬/ ‫ ﻻ ﻳﻤﻜﻦ إﻟﻐﺎؤﻫﺎ أﺛﻨﺎء اﺳﺘﻤﺮار وﺟﻮد أي ﺗﺴﻬﻴﻼت ﻗﺪ ﺗﻤﻨﺢ ﻟﻲ‬.ii
.‫وﻟﻜﻦ ﻳﻤﻜﻦ إﻟﻐﺎؤﻫﺎ ﻓﻘﻂ ﻋﻨﺪ إﻧﻬﺎء ﺗﻠﻚ اﻟﺘﺴﻬﻴﻼت‬
‫ﻧﻘﺪﻣﻬﺎ ﻟﻠﺤﺼﻮل‬/‫ ﺳﺘﻜﻮن ﻗﺎﺑﻠﺔ ﻟﻠﺘﻄﺒﻴﻖ ﻋﻠﻰ ﺟﻤﻴﻊ اﻟﻄﻠﺒﺎت اﻟﺘﻲ ﻗﺪ أﻗﺪﻣﻬﺎ‬.iii
‫ﻣﺸﺎرﻛﻴﻦ ﻓﻲ اﻟﻄﻠﺐ إﻣﺎ‬/ً‫ﻛﻨﺎ ﻣﺸﺎرﻛﺎ‬/‫ﻋﻠﻰ ﺗﺴﻬﻴﻼت اﺋﺘﻤﺎﻧﻴﺔ ﻣﻦ اﻟﺒﻨﻚ إذا ﻛﻨﺖ‬
‫ﺿﺎﻣﻨﻴﻦ وأﻳﻀًﺎ ﻟﻐﺮض ﺗﺴﻬﻴﻞ ﺗﻘﻴﻴﻢ اﻟﻤﺨﺎﻃﺮ ﻟﻤﻨﺢ‬/‫ﻛﻤﻘﺘﺮﺿﻴﻦ أو ﺿﺎﻣﻦ‬/‫ﻛﻤﻘﺘﺮض‬
‫أي ﺗﺴﻬﻴﻼت إﺿﺎﻓﻴﺔ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺄي ﺗﺴﻬﻴﻼت اﺋﺘﻤﺎﻧﻴﺔ ﻣﻮﺟﻮدة ﺣﺎﻟ ًﻴﺎ أو ﻗﺪ ﺗﻨﺸﺄ‬
.‫ﻓﻲ اﻟﻤﺴﺘﻘﺒﻞ‬
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Signature
‫اﻟﺘﻮﻗﻴﻊ‬
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