LOAN APPLICATION FORM

NEW [ ] RENEWAL [ ]

421 Sulucan St., Bgy. Cupang, Antipolo City PHOTO

Tel No. 542-6707 Cel. No. 0920 9618181

LOAN AMOUNT DESIRED: ______________________ TERM: _______ MONTH/S [ ] _______ DAYS [ ]

PERSONAL INFORMATION
LAST NAME FIRST NAME MIDDLE NAME

COMPLETE HOME ADDRESS

HOME USE LENGTH OF STAY PLACE OF BIRTH

OWN [ ] RENT [ ] FREE USE [ ] _________ YEARS & _________ MONTHS
BIRTH DATE AGE SEX CIVIL STATUS

SPOUSE’S MAIDEN NAME NO. OF DEPENDENTS NO. OF STUDYING TEL. NO./ CEL. NO.

FATHER’S NAME ADDRESS TEL. NO./ CEL. NO.

MOTHER’S NAME ADDRESS TEL. NO./ CEL. NO.

HOME PHONE NUMBER FACEBOOK NAME/ACCOUNT EMAIL ADDRESS

SMART/TNT NUMBER GLOBE/TM NUMBER EDUCATIONAL ATTAINMENT

BUSINESS/EMPLOYMENT
BUSINESS NAME / EMPLOYER’S COMPANY NAME INCOME / SALARY DATES

COMPLETE ADDRESS POSITION

NATURE OF BUSINESS /WORK BUSINESS / WORK TEL. NO. YEARS IN BUSINESS / WORK
_________ YEARS & _________ MONTHS
CONTACT PERSON CONTACT PERSON CEL. NO. NET INCOME / SALARY PER MONTH

OTHER INCOME
SPOUSE’S MONTHLY INCOME AMOUNT

REMITTANCES FREQUENCY AMOUNT

SIDELINE / OTHERS (PLEASE SPECIFY) MONTHLY INCOME

CREDIT REFERENCES
CREDITOR CONTACT NO. LOAN AMOUNT AND STATUS

BANK NAME CONTACT NO. ACCOUNT NO.

CO-MAKER INFORMATION
FULL NAME CONTACT NO.

COMPLETE ADDRESS BUS. NAME/ EMPLOYER’S NAME

PERSONAL REFERENCES
NAME ADDRESS CEL. NO.

NAME ADDRESS CEL. NO.

NAME ADDRESS CEL. NO.

I hereby certify that all the information given above in this credit application is true to my own personal knowledge. I here-
by authorize RIGHT RESOURCES MICRO-CREDIT CORPORATION, or any of its authorized representatives to conduct the
required investigation hereon.

Do not write below this line SIGNATURE DATE

CI BY : _____________________________________ DATE : _______________________

ACTION TO BE TAKEN: APPROVED [ ] NEEDS FURTHER EVALUATION [ ]

AUTHORIZED SIGNATURE DATE

AMOUNT APPROVED: ______________________ TERM : ________________________