Application Form

SEAMAN AND OFW LOAN

Loan Consultant: _______________________________ Contact no: _______________________ Purpose of Loan: ______________________________

Borrower’s Information
Name : Gender : Age: Birthdate :
Present Address : Civil Status :
Provincial Address : Religion :
Permanent Address :
Education : High school Graduate High school Level College Level College Graduate
Year Graduated : School Last Attended : FB Account Name :
Course : Email Add : Mobile Number :
Spouse Name : Birthdate: Age: Contact no:
Provincial Address : FB Account Name:

No. of Dependents: ___________

Name of Children Age /Civil School OR Employer/Business Residence Address Net Income
(full name) Status

House Ownership:
_______ Owned _______ Mortgaged _______ Used Free _______ Renting ________Others:
Amount of Rent/Amortization _________________ Length of Stay: _______________ Nearest Landmark: ________________________________________
Electric or Water Bill Registered Name: ________________________________________________ Relation:______________________________
Assets:
Vehicle Model – Plate No. Mo. Amortization Kind / size of Property Location

Co –borrower’s Information
Name : Gender : Birthdate : Age :
Relation to borrower : FB account : Civil Status :
Education : High school Graduate High school Level College Level College Graduate

Year Graduated : School Last Attended : Course :

Home phone no : Mobile No: Email Address :

Character Reference (at least 2 relative and 2 friend)

Name Address Contact Number Relation
1
2
3
4
5

Manning / Crewing Agency

Name of Agency
Office Contact No. (LandLine)
Crewing Manager / Informant

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 trueand genuine. I/We
hereby authorize Global Dominion Financing Incorporated to obtain such information may be required concerning the validity and veracity of information provided, using any
applicable methods or processes, including my/our loan and deposit accounts, and waive my/our rights under R.A. 1405. I/We further agree that this application and all supporting
documents and any other information obtained by Global Dominion relative to this application shall remain as Global Dominion’s property whether or not the loan is granted. I/We
agree that Global Dominion has no obligation to furnish me/us the reason of such rejection. I/We also understand that any false statement or concealment of information which
may be discovered after the loan has been granted shall be sufficient basis for Global Dominion to consider the loan due and demandable immediately.

___________________________________ ______________________________________
Borrower’s Signature over printed name Co -Borrower’s Signature over printed name

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 the 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 you “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 Global SME 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 Global SME to disclose and collect information from the above – mentioned institutions and
people.

_________________________________________
Borrower (Signature over printed name)