Make it Happen Loan Application Form

Consent to Disclose and Request. (A) to Republic Bank disclosing to any third party (specifically including those providing credit bureau services, insurance and other financial services) my credit and other information held by Republic Bank (including applications for credit or other products/services, related analytics data and such information as necessary for the provision of insurance coverage quotes and insurance coverage to me in relation to any product/service provided to me by Republic Bank); and (B) to any third party (specifically including those providing credit bureau services, insurance and other financial services), upon request by Republic Bank, disclosing to Republic Bank my credit, employment or other information (including applications for credit or other products/services and related analytics data).

Continuance of Consent. That this consent shall be applicable to all applications made by me as borrower, guarantor or in any other capacity with Republic Bank and shall be valid from the date signed and continue throughout the existence of all credit or other facilities with Republic Bank.

Indemnity. I will indemnify Republic Bank against any and all claims, damages or otherwise arising from my consent herein to all disclosure and/or requests from and to Republic Bank.

Independence. That this consent is given of my free will and without duress from any third party, including Republic Bank, and with all authority necessary to give the consent.

Accuracy. That the information provided is true and correct and that Republic Bank will reply of such information in considering my application(s) for banking products/services.