Loan details Loan amount* CHF Please enter an amount Duration* Months Please enter the number of months Credit protection Yes No This provides additional security for your installment payments in the event of disability or involuntary unemployment. Credit protection is optional. Personal data Title* Mr. Mrs Please select your title First name* Please enter your first name Last name* Please enter your last name Date of birth* Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 Please select your birthday Street/Nr.* Please enter the name and house number of the street ZIP/Location* Please enter postal code and city Country* Please choose an option Switzerland Germany Austria France Italy Please select a country Private Phone Mobile Phone Email Civil status* Please choose an option Single Married Widowed Divorced Judicially separated Please select your civil status Nationality* Please choose an option Switzerland Liechtenstein Germany Austria France Italy —————————– Afghanistan Aland Islands Albania Algeria American Oceania American Samoa American Virgin Islands Andorra Angola Anguilla Antarctica Antigua und Barbuda Argentina Armenia Aruba Azerbaijan Australian Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Virgin Islands British territory in the Indian Ocean Brunei Bulgaria Burkina Faso Burundi Chile China Cook Islands Costa Rica Ivory Coast Democratic Republic of Congo Democratic People's Republic of Korea Germany Djibouti Dominica Dominican Republic Denmark Ecuador El Salvador Eritrea Estonia European Union Falkland Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Territories Faroe Islands Gabon Gambia Georgia Ghana Gibraltar Grenada Greece Great Britain Greenland Guadeloupe Guam Guatemala Guernsey Guinea 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Zambia Samoa San Marino Sao Tome and Principe Saudi Arabia Sweden Switzerland Senegal Serbia Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia Hong Kong Special Administrative Region Macao Special Administrative Region Spain Sri Lanka St. Barthélemy St. Helena St. Kitts and Nevis St. Lucia St. Martin St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Syria South Africa South Georgia and the South Sandwich Islands Tajikistan Taiwan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Chad Czech republic Tunisia Turkmenistan Turks and Caicos Islands Tuvalu Turkey Uganda Ukraine Unknown or invalid region Hungary Uruguay Uzbekistan Vanuatu Vatican City Venezuela United Arab Emirates United States Vietnam Wallis and Futuna Christmas Island Belarus Western Sahara Central African Republic Zimbabwe Cyprus Egypt Equatorial Guinea Ethiopia Outer Oceania Austria other Please select your nationality Permit* Please choose an option B C L G Diplomat Bitte wählen Sie Ihren Ausländerausweis Date of entry Day 01 02 03 04 05 06 07 08 09 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 Cross border from Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 Profession & Income Professional situation* Please choose an option Employed indefinitely Contract for a fixed term Temporary Independent IV pensioners AHV pensioners Housewife/househusband Unemployed Student Please select your professional situation Monthly income included (part-time work, pensions, etc.)* Please enter your monthly income Living & Expenses Housing situation* Please choose an option Married couple Single Single in household with adults Please state your living situation 2. Enter applicant* Yes No Please select an option Professional situation* Please choose an option Employed indefinitely Contract for a fixed term Temporary Independent IV pensioners AHV pensioners Housewife/househusband Unemployed Student Please select an option Monthly income included (part-time work, pensions, etc.) Children in the same household (under 18)* Yes No Please select an option Up to 6 years 0 1 2 3 4 5 6 7 8 9 Over 6 to 10 years 0 1 2 3 4 5 6 7 8 9 Over 10 to 12 years 0 1 2 3 4 5 6 7 8 9 Over 12 years 0 1 2 3 4 5 6 7 8 9 Open debt collections* Yes No Please select an option Remarks / Questions Fields marked with * must be filled in. Legal Notes* The granting of credit is prohibited if it leads to overindebtedness (art. 3, LCD). I have read the Terms and Conditions and i accept them. Missing or invalid information Please fill in all mandatory fields. Ok
