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Sourcing Data:

Source Code: _____________________________________________

Referror / Account Officer / DSA: ______________________________________________________________


APPLICATIONS WITH INCOMPLETE DOCUMENTS AND INFORMATION WILL NOT BE PROCESSED.
PERSONAL LOAN DETAILS
With previous or existing Security Bank Personal Loan?
Desired Loan Amount
PHP

PERSONAL REFERENCES

SPOUSE INFORMATION

Channel Source:

Yes

12

Appliance

Middle

MANUEL

DE GUZMAN

Date of Birth (mm/dd/yyyy):

18

Tuition Fees

24

36

Name
1.

VILLAREAL

CHONA M.

College

Position:

Business / Employer Address (Floor, Street, Brgy./Village, Subdivision, City/Municipality, Province):

Credit Card
1.

Zip Code:

Number of Dependents:

Office Phone No.:

Branch: _____________________________

09332095365

Account Type: ____________________________

Children:

N/A
(Relationship:________________)

Others:

Employment Type:
Position:

PERSONAL INFORMATION
Title:
Name:
First

Government

Mr.

Mrs.

Gender:
Middle

AMELIE ROSE
Mothers Maiden Name

Civil Status:

ELSA HAMLAG BALAKID

Car Ownership:

Home Ownership:

Legally Separated

Married

Annulled

Supervisor

Post Graduate

Others: __________________

College

Personal, monthly amortization (PHP ____________)

Manager / Senior Manager

Permanent:
Y

Date of Hire:

Length of Service:

SEPT. 16, 2005

10 YEARS
SSS/GSIS/UNIFIED ID Number:

223-881-595
Company Provided

Both

None

Owned

Living with relatives

Rented, PHP______________/mo.

Mortgage

Length of Stay: __________ years

Business / Employer:

CORITHIAN COMMERCIAL CORP.


Business / Employer Address (Floor, Street, Brgy./Village, Subdivision, City/Municipality, Province):

Zip Code:

Zip Code:

7/2 SUNVAR PLAZA BLDG. AMORSOLO MAKATI CITY


Office Phone No.:

Fax No.:

817-8211

2260 ASUNCION ST. MALATE MANILA


N/A

Mobile Phone No.:

E-mail Address:

Gross Monthly Income:


Telephone No.:

8AM - 5PM

817-8211

Immediate Supervisor / HR Contact Person:


Zip Code:

CHONA M. SALDANA

N/A
Preferred Billing / Mailing Address:

Business / Employer

4404-5308-5877-9234 10/20

HSBC

5447-5880-0533-0158 01/20

120,000.00

Outstanding Balance

N/A

N/A

N/A

N/A

Type of Loan

Monthly Payment

N/A

N/A
N/A

N/A

I hereby certify that all information herein are true and correct based on my own knowledge and further authorize
the Bank to obtain information as it may require concerning my loan application and agree that it shall remain the
Banks property whether my loan is approved or not. Any information given by me or other persons I authorized
which is not true or accurate, will automatically cause the Bank to reject my loan or cancel its approval.
I hereby willingly, voluntarily, and with full knowledge of my right under the law, waive the right to confidentiality
of information and authorize the Bank to disclose, divulge and reveal any such information relating to the account of
the Borrower/Mortgagor, including events of default, for the purpose of, among others, client evaluation, credit
reporting or verification and recovery of the obligation due and payable to the Bank under the terms and conditions
of this agreement.
In view of the foregoing, the Bank may disclose, divulge and reveal the aforementioned information to third
parties, including but not limited to my employer, the Banks affiliates, subsidiaries, agents or services providers, the
Bankers Association of the Philippines Credit Bureau (BAP CB) or to any similar central monitoring entity or
recipients as provided for by law and required by competent authority.
I further authorize the Bank, as my Attorney-in-Fact, to conduct random verification with the Bureau of Internal
Revenue (the "BIR") in order to establish the authenticity of my Tax Statements (the "ITR) and the accompanying
financial statements/documents submitted to the Bank in accordance with banking regulatory requirements.
I hold the Bank free and harmless from any and all liabilities, claims and demands of whatever kind or nature in
connection with or arising from the aforementioned disclosure or reporting.
I hereby acknowledge that the Personal Loan or any part(s) thereof shall be deemed to have been availed on
the date when the funds are transferred to my bank account maintained with the Bank, or upon receipt of the
Managers Check, reflecting the amount of the loan less the applicable fees, charges and taxes.
I further authorize the Bank to deduct from my Loan proceeds all fees including, but not limited to, processing
fees, documentary stamp tax, notarial fees and interest accruals should the first due date be over 30 days from the
release of my loan and other related charges.
I likewise authorize the Bank to provide me with a consumer loan or additional bank product/s (such as but not
limited to auto, housing, credit card and other products suited to my situation) at the Banks sole discretion. My
acceptance of the credit card or the proceeds of any loan released pursuant thereto shall be conclusive proof of my
acknowledgement of my additional obligations and/or indebtedness to the Bank under the Terms and Conditions set
forth by the Bank and prevailing at the time the credit card is issued or the additional loan is approved.
I hereby agree that the Bank has the right to approve a lower amount than my desired loan amount as indicated
in this application and shall render the Bank free and harmless from any liability arising thereof.
I hereby agree that should my application be denied, the Bank has no obligation to furnish the reason for such
rejection or to return my application and other submitted documents.
I also legally bind myself to the Terms and Conditions of the Loan Program Promissory Note, Disclosure
Statement and other relevant documents that I shall execute in favor of the Bank.

Borrower's Signature Above Printed Name

Zip Code:

N/A
Length of Service:

Home

UNION BANK 200,000.00

Name of Previous Employer:

2260 ASUNCION ST MALATE MANILA


Previous Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province)*:

Expiry Date

30,000.00 PER MONTH

Best Time / Day to Call:

09228886887

Permanent Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province)*:

Card No.

UNDERTAKING

President / Chief Executive Officer / Director / Chairman


Nature of Business:

TIN:

Present Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province)*:

Home Phone No.:

2.

Assistant Vice President / Senior Assistant Vice President

REAL ESTATE

TAGUM CITY

Vocational

Credit Limit

Bank / Company
1.

Self-Employed

Widow/Widower

Place of Birth:

High School

817-8211

VISOR

Vice President / First Vice President / Senior Vice President / Executive Vice President

Single

10/06/1978

Company-Owned

VILLAREAL

Date of Birth (mm/dd/yyyy):

FILIPINO

Last

LAGARE

Educational Attainment:

Junior Officer

Assistant Manager / Senior Assistant Manager


Ms.

Citizenship:

Rank and File

Private

SUPER-

MAKATI CITY

OTHER LOAN ACCOUNTS

MY WORK AND FINANCES


Acct. No.

843-8406

2.

2260 ASUNCION ST. MALATE MANILA

Credit to my Security Bank Account:

Telephone No.

CREDIT CARD DETAILS

TECNICHIAN

Personal Consumption

Via Managers Check

MATE

SALDANA

Others: ____________________________
Mode of Loan Release:

MAKATI CITY

GENER

Others: __________________

OWN

Relationship

OFFICE-

2.

Educational Attainment:
High School
Vocational
Post Graduate

Address

LORDITA

Last

Business / Employer:

Payment term (Months)

Loan Purpose:

Mrs.

08/19/1967

No

100,000.00

Mr.

Spouse:
Name:
First

FOR BANKS USE ONLY


Total Years at Work / in Business:

N/A

10 YEARS

Date

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