APPLICATION FORM

(Please provide all the information requirements to avoid delay in processing / Incomplete Application Forms will not be processed)

Applicant Information PLEASE WRITE IN BLOCK LETTERS. PLACE N.A. WHERE NOT
APPLICABLE
Applicant Last Name First Name Middle Name Amount Applied for Date of Application

Purpose ( ) Educational Loan ( ) Appliance Loan ( ) House Equity ( ) Business/Livelihood ( ) Others

( ) House Improvement ( ) Car/Motorcycle Loan ( ) Medical Assistance Please Specify:__________ Please Specify:__________
Term Desired ( ) Semi-monthly ( ) 6 mos. ( ) 9 mos. ( ) 12 mos. ( ) 18 mos. ( ) 24 mos. ( ) 30 mos. ( ) 36 mos.
Present Employer Employee No. Position Department Date Hired Nationality

Length of Service Monthly Salary Immediate Head Position Phone No. & Local
( ) # of Years ( ) # of Months
Sex ( ) Male Age Birth Date Status ( ) Single ( ) Widowed Home Phone No.
( ) Female ( ) Married ( ) Living Together Cellphone No.
Permanent/Provincial Address Yrs. Mos.
Length of Stay
Home Address Street District/Village/Barangay City Yrs. Mos.
Length of Stay
Residence Type ( ) Owned ( ) Living with parents/relatives
( ) Owned, mortgaged. How much? _______________ ( ) Rented. How much? _______________
Spouse’s Name Last Name First Name Middle Name Birth Date

Spouse’s Present Employer Address Length of Service Phone No. & Local
( ) # of Years ( ) # of Months
Present Position Spouse’s Monthly Salary No. of Children (include ages)

Youngest Child in School School Course Year

Name
Nearest Relative Not Living With You Address Relationship Home Phone No.
Name Cellphone No.
Tax Identification No. SSS No. Residence Certificate No. Place of Issue Date of Issue

The above statement are submitted for the purpose of obtaining credit and are certified to be true and
correct. I hereby authorize Creditor or its authorized representative to conduct the corresponding credit
verification on this application. I understand that any false statement or material omission may lead to the
rejection of my application. Applicant’s Signature
Co-Maker Information PLEASE WRITE IN BLOCK LETTERS
Applicant Last Name First Name Middle Name Birth Date Status ( ) Single ( ) Widowed
( ) Married ( ) Living Together

Permanent/Provincial Address Yrs. Mos.

Length of Stay
Home Address Street District/Village/Barangay City Yrs. Mos.
Length of Stay
Residence Type ( ) Owned ( ) Living with parents/relatives
( ) Owned, mortgaged. How much? _______________ ( ) Rented. How much? _______________
Employer Name Address Length of Service
( ) # of Years ( ) # of Months
Employee No. Position Department Date Hired Phone No. & Local

Monthly Salary Immediate Head Position Cellphone No.

Spouse’s Name Last Name First Name Middle Name Birth Date

Spouse’s Present Employer Address Length of Service Phone No. & Local
( ) # of Years ( ) # of Months
Present Position Spouse’s Monthly Salary No. of Children (include ages)

Youngest Child in School School Course Year

Name
Nearest Relative Not Living With You Address Relationship Home Phone No.
Name Cellphone No.
Tax Identification No. SSS No. Residence Certificate No. Place of Issue Date of Issue

The above statement are submitted for the purpose of obtaining credit and are certified to be true and
correct. I hereby authorize Creditor or its authorized representative to conduct the corresponding credit
verification on this application. I understand that any false statement or material omission may lead to the
rejection of my application. Co-Maker’s Signature
CERTIFICATION
(To be accomplished by the company administration)
( ) It is hereby certified that applicant and co-maker are employees of this company.
( ) Data on position, length of service and salaries of applicant and co-maker are accurate.
( ) Applicant/Co-Maker are employees in good standing in the company. There are no pending cases against
them as of date within the company.
( ) Any exemptions/comments

Authorized Signatory
FOR LENDER’S USE ONLY
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