MONTSERRAT - Gov



FORM 22 MF

FORM OF APPLICATION FOR AND APPROVAL OF LOAN FOR THE PURCHASE OF

________________A MOTOR CAR (G.O. No. 505)_______________________

BEFORE completing this form READ carefully ALL the NOTES on Page4.

PART A (to be completed in triplicate by the applicant)

APPLICATION FOR A LOAN FOR THE PURCHASE OF A MOTOR CAR

1. Full Name _____________________________

(Please PRINT your Surname)

Ministry/Department _________________________________________.

Substantive Post ____________________________________________.

Present Salary and Scale No. ____.

I hereby apply, in accordance with the terms of G.O.No.505, for a loan for the purchase of a motor car as follows:-

Cost of Repairs $________________

Comprehensive insurance $________________

Less Payment by Borrower $________________

Amount of Loan $________________.

Period of Loan ________________ years

Description of Car _________________.

Make ______________________.

Manufacturer’s ______________________.

______________________.

Model No. and year _________________.

Engine No. & capacity _________________.

New or second hand _________________.

Dealer’s Name ______________________.

I have the following personal financial liabilities/commitments unpaid debits:-

Monthly/Total To Whom Payable For What Purpose

3. Sum Payable

(See $

Note3)____________ _______________ ________________

____________ _______________ ________________

____________ _______________ ________________

____________ _______________ ________________

____________ _______________ ________________

I certify that this information is true, that the sums above stated constitute my full personal indebtedness and that repayment of the loan for which I am applying will not cause me financial embarrassment.

(Date)_______________ (Signature)_______________

Authority to Accountant General

If the loan is granted to me I ________________ hereby authorise the Accountant General to deduct from my monthly salary such sum as may be required to repay the loan of $_________ and subsequent loans not exceeding $_________annually for renewal of Comprehensive Insurance Policy together with all interest charges thereon over a period of _______ years/months.

(See Note 4)

(Date)_____________ (Signature)____________________

PART B (To be completed by the applicant’s Permanent Secretary

Head of Department)

RECOMMENDATION AND CERTIFICATE BY PERMANENT SECRETARY/

HEAD OF DEPARTMENT

1. I RECOMMEND/DO NOT RECOMMEND the application.

2. I CERTIFY that:

i) Mr/Mrs/Ms ___________________________ is a

Designated “Travelling Officer” for the purpose of G.O. 504 and that he requires a motor car for the specific performance of his official duties; and

ii) After due enquiry I have personally satisfied myself to the best of my knowledge and belief that the statement made by

Mr/Mrs/Ms ______________ in paragraph 3 of

PART A is true and accurate as to detail.

(Signature)______________________________.

Permanent Secretary,

Ministry of _____________________________.

(Date) __________ Head of Department ______________________.

______________________________________________________________

PART C (to be completed by Financial Secretary)

APPROVAL OF APPLICATION

I APPROVE Mr/Mrs/Ms ___________________’s application.

I DO NOT APPROVE Mr/Mrs/Ms ____________’s application.

(Date) ________________ (Signature) __________________.

Financial Secretary

1) ONLY officers designated as “Travelling Officers” are eligible for loans for the purchase of motor cars.

2) Form 22 MF is to be completed in TRIPLICATE as follows:

PART A By the Applicant who will submit ALL copies to his Permanent Secretary or Head of Department as may be appropriate.

PART B By the Applicant’s Permanent Secretary or Head of Department who will submit ALL copies to the Permanent Secretary, Administration.

PART C By the Financial Secretary.

(3) Full details of ALL personal indebtedness must be given mortgage repayments, hire purchase instalments, bank loans, salary advances, personal I.O.U.’S, existing motor cars etc. Failure to disclose any item may result in the application being refused.

(4) The maximum periods for which loans are available are:-

For New cars 5 years

For Second-hand cars 3 years

(5) PART B must be signed personally by the applicant’s Permanent Secretary, or if the applicant holds a post in a extra-ministerial department, by his/her Head of Department.

Permanent Secretaries and Heads of Department are advised that they should not recommend applications unless they are fully satisfied, after such investigation and enquires as they deem it necessary to make, that the applicant can afford to repay the loan without financial embarrassment.

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