Service is the Difference

LOAN APPLICATION FORM

Loan Products: Collateral Details:
Non - Collateral Loans Collateral Loans Make Year Model:
Series Plate no:
Personal Loan (OFW/Seaman) Car Loan/Car Loan Take out
Loan Purpose Clinic renovation Loan Terms:
Pinoy Abroad Loan 2nd Hand Car Financing
Applied amount 1,000,000
Doctor’s Loan Truck Loan
Business Loan 2nd Hand Truck Financing How did you know Global Dominion: Walk in Website/ Social Media

Salary Loan Others: Name of Loan Consultant:

BORROWER’S PERSONAL INFORMATION

NAME (Last name, First name, Middle name) Gender Birthdate Civil Status Gender Religion
Rodriguez, Arnold Soliman Male 11/17/62 Married Male Catholic
Education: Course Home phone no.: N/A
High school Graduate College Graduate Mobile Number: 09474170677
High School Level College Level Doctor of Medicine Email Address: [email protected]
School Last Attended Year Graduated SSS no. 33-4952881-3 Facebook Account:
Fatima College of Medicine 1988 TIN 274-974-236-000 Other Contact nos.
Present Address Length of stay
160 Mc Infante St.,Brgy.Tinampo,Palapag,Northern Samar 5yrs
House Ownership Permanent Address 160 Mc Infante St.,Brgy. Tinampo,Palapag,Northern Samar
Owned (Not mortgaged) Rented (Php /mo.) Provincial Address same as above
Owned (mortgaged) Used Free Parent’s Address
No. Of dependents:
Name Age School Relation
Emmanuel T. Rodriguez 25 University of Eastern Phillipines Son

Do you own a motor vehicle: YES Make: Toyota Grandia GL Year Model: 2019 Plate number: HAB 4851

INCOME INFORMATION
Employer/ Business Name Position Monthly Income Length of stay/ Yrs in Business
RODRIGUEZ MEDICAL CLINIC Physician/Owner 120,000 5yrs
Employer/Business Address Professional License No. Employer/ Business Tel. No.
160 Mc Infante St.,Brgy.Tinampo,Palapag,Northern Samar 70556 09474170677
SPOUSE/ CO-BORROWER PERSONAL INFORMATION
NAME (Last name, First name, Middle name) Relation to borrower Civil Status Birthdate Age Facebook Account
Rodriguez,Nida Torio wife Married 10/14/67 54
Education: Course Medicine Home phone no.: N/A
High school Graduate College Graduate School last attended: Fatima College of Medicine Mobile number: 09474170677
High School Level College Level Year graduated: 1988 Email Address:
Source of Income: Employer/ Business Name: Employer/ Business Address: Employer/ Business Contact no.
Fishpond business Self-employed n/a 09474170677

CHARACTER REFERENCES OTHER SOURCES OF INCOME

Name Address Contact Number Name of Employer/ Business
1 Jhamella De Los Reyes Brgy.SMH,Laoang,Northern Samar 09453565822

2 John Dave De Guzman Brgy.Tinampo,Palapag,Northern Samar

09369093485 Address of Employer/ Business
3 Alfred Reyes Brgy.Asum,Palapag,Northern Samar 09951584386

4 Yrs. in service/ business Monthly Income

5

UNDERTAKING
I/We hereby certify that all the information furnished in this Application Form are true, correct and complete, and that the signatures herein are true and genuine. I/We hereby
authorize GLOBAL DOMINION FINANCING INC. to obtain such information as may be required concerning the validity and veracity of the information provided in this
application. I/We further agree that this application and all supporting documents and any other information obtained by GDFI relative to this application shall remain as
property of GDFI whether or not the loan is granted. I consent to th forfeiture of the processing fee that I paid to GDFI in case I cancel, withdraw or terminate my loan
application without fault of GDFI. I/We agree that any false statement or concealment of information which may be discovered after the loan has been granted shall be
sufficient basis for GDFI to consider the loan due and demandable immediately.

Arnold S. Rodriguez,MD Rodriguez,Nida Torio 5/03/2022

Borrower (Signature over printed name) Spouse (Signature over printed name) Date
PRIVACY NOTICE AND CONSENT FORM
The privacy and security of your personal data (”Personal Information”) which we collect from you is important to us. It is equally important that you understand how we
handle this data.
In conducting our business, we must collect “Personal Information” from you. It will be strictly used to administer your account and to provide the products and services
you have requested from us and to further meet your needs and the standard procedures of our business. We will treat your “Personal Information” confidential. It will
only be disclosed, subject to our permission, to our affiliates such as credit bureaus, collection companies and other financial institutions for the purpose of assisting you in
your financial needs and for the effective handling of your account. Further, for the proper assessment of your loan application, you hereby allow GDFI to collect
information from any institutions that you are connected with or related to such as but not limited to banks, agencies, employer, airlines and supplier. Furthermore, in case
of restructuring your loan obligation, you are giving consent and allowing GDFI to disclose and collect information from the above-mentioned institutions and people.
For further information regarding the privacy policy, you may visit our website st www.gdfi.com.ph
Arnold S. Rodriguez,MD
Borrower (Signature over printed name)
 N/A

BDO Catarman,Northern Samar Savings Acct. 008120111902

Application Requirements: MAIN OFFICE: Unit 203 Jollibee Plaza Condominium, Emerald Ave., Ortigas, Pasig CIty
21-59 years old upon loan maturity BRANCHES:
Filipino citizen South GMA North GMA North Luzon Visayas Mindanao
Must Have contact Numbers Calamba Sucat Antipolo Angeles Laoag Bacolod Butuan
Basic Documentary Requirements: Cavite San Pablo Cainta Baguio Malolos Cebu CDO
Completely filled-up application form Imus Lagro Baler Meycauayan Consolacion Davao
2x2 picture Intramuros Marikina Baliuag San Jose Dumaguete Digos
Latest/original proof of billing (Meralco/Water) Las Piñas POEA Bataan Olongapo Iloilo Gensan
2 Valid ID’s Lipa Quezon Ave. Cabanatuan Pampang Kabankalan Kidapawan
Co-maker Requirements: Makati San Mateo Cauayan Santiago Mandaue Koronadal
2x2 picture Manila Tanay Dagupan Tarlac Roxas Malaybalay
2 valid ID’s Muntinlupa Valenzuela Gapan Tuguegarao Taclobal Tagum
Latest/original proof of billing (Meralco/Water) Naga Visayas Ave. La Trinidad Tagbilaran Valencia
Proof of income (Payslips, Business Permit) Pasay La Union

LOAN PRODUCTS OFFERED:

NON-COLLATERAL COLLATERAL
Personal Loan - OFW Car Loan
Personal Loan - Seaman 2nd Hand Car Financing
Business Loan PUV Loan
Salary Loan Taxi Loan
Doctor’s Loan Truck Loan
Real Estate Loan
Tricycle Loan
2nd Hand Truck Financing