U.S.

AID-PHILIPPINES PARTNERSHIP
BUSINESS FUNDING PROGRAM
APPLICATION FORM

IMPORTANT APPLICANT INFORMATION : Due to the increasing increase in unpaid loans by borrowers as well as loan fraud and under the legislative
provisions in force in the Philippines allowing multinational financial company/institutions to collect sufficient data to verify borrowers identity as well as
any information they will have to provide about their various business, you will therefore have to take care to fill out this form correctly by answering all
the questions correctly and providing the pre-required documents.

For this purpose, MEAZER LENDING Corporation, reserves the right to use external sources (BIR, DTI, ECCP, BAP & INTERPOL) for in-depth verification of
the data collected in order to optimally evaluate applicants funding request files.

Application Reference Number :

Applicant mobile phone number :

Applicant email :

Applicant Home & Business address :

GENERAL INFORMATIONS

Legal Business Type : ❑ C-Corporation ❑ Subchapter-S ❑ Partnership ❑ Sole Proprietorship

❑ Nonprofit Organization ❑ Other:

Annual turnover : ❑ ≤ $100,000 ❑ $ (100,000-250,000) ❑ ≥ $250,000

Applicant business turnover of the last three years :

Has your business undergone tax reassessment once by BIR : ❑ Yes ❑ No

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 U.S.AID-PHILIPPINES PARTNERSHIP
BUSINESS FUNDING PROGRAM
APPLICATION FORM

Applicant business / company name :

Number of employees working in the applicant's business / company :

Applicant Business / Company Taxpayer Identification Number (TIN) :

Date of creation of the company/business or start of activities :

Name of the persons who are authorized signature on the company's bank accounts and their position :

The company currently benefits from government subsidies? ❑ Yes ❑ No

LOAN REQUEST

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 U.S.AID-PHILIPPINES PARTNERSHIP
BUSINESS FUNDING PROGRAM
APPLICATION FORM
Amount Requested $ : ❑ Secured ❑ Unsecured ❑ Initial Request ❑ Additional Advance

Purpose of Loan : ❑ Working Capital ❑ Purchase Equipment ❑ Purchase Real Estate ❑ Other:

Please provide a brief description of the business activity you want to with a loan and how much you want to
borrow :

OWNERSHIP

Be sure to fill in the table below, the information of the shareholders, members of the board of directors or
different owners of the company in which the funds that are the subject of this loan request will be invested. It
is noted that by filling out and signing this form, they automatically vouch for the loan if it is finally granted for
the benefit of the said business / company.

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 U.S.AID-PHILIPPINES PARTNERSHIP
BUSINESS FUNDING PROGRAM
APPLICATION FORM
Years in
Name Date of Title Ownership % This
Birth Business

NOTICE OF APPROVAL OF CREDIT: Applicant will receive an official notification letter, which will be followed by the notary
contract of the loan, a certificate on honor and an escrow agreement. All those documents must be duly signed,
formalized, registered and legalized by the notary with the competent authorities

EQUAL CREDIT OPPORTUNITY NOTICE: The american equal credit opportunity act prohibits creditors from discriminating
against applicants on the basis of race, color, religion, national origin, sex, marital status, age (providing the applicant
has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from public
assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection
Act.

LIST OF DOCUMENTS TO BE ATTACHED TO THE DULY COMPLETED AND SIGNED FORM :

- Business owner or company CEO identity proof here by providing valid passport copy or national ID
card pictures (front and back)

As well as for all shareholders, members of the board of directors or owners of the company

- Business / Company DTI registration and/ or Certificate of incorporation

- Business / Company's tax certificate dating back less than a year

- Business permit(s) & Company monthly income or/and gross revenues proof

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 U.S.AID-PHILIPPINES PARTNERSHIP
BUSINESS FUNDING PROGRAM
APPLICATION FORM

SIGNATURES : By signing below, loan applicant submits this application and the information provided on all
accompanying financial statements and schedules for the purpose of obtaining credit and represents that
the information submitted is accurate and complete. Loan applicant acknowledges that representations
made in this application will be relied on by lender in evaluating this application and, if approved, in
extending credit. loan applicant represents that none of the parties named in this application have relied on
advice from the lender in applying for or receiving any credit. Loan applicant acknowledges that lender has
not made any commitment to approve this application and extend credit, unless otherwise agreed to in
writing. Lender is authorized to conduct any inquiries it decides are necessary to verify the accuracy of the
information contained in this application and to use any reasonable method to determine the
creditworthiness of the loan applicant. Loan applicant will promptly notify lender of any subsequent changes
which would affect the accuracy of this application, and will provide all documents and information that
lender decides are necessary to complete this application.

In addition, each individual signing below authorizes the lender to check their individual credit account and
employment history and have credit reporting agency prepare a consumer credit report on them.

The information contained herein is true to the best of my knowledge and belief. I understand that the
lending company (MEAZER LENDING Corporation) will be relying on the information contained herein as it
makes a determination regarding my loan application and future loans or loan renewals to the undersigned.

By_________________________________________ By______________________________________________

Signature Date Signature Date

By__________________________________________ By______________________________________________

Signature Date Signature Date