Supplier Referred By (Salesman/Agent) Branch Application No.

Item Applied For Cash Price GuarantyDep./Downpayment Amount Financed Term AOR

Last Name First Name Middle Name Age Birthdate (MM/DD/YY)

Nationality Civil Status Education No of Dependents

Single Widow/Widower Post Graduate

Married Separated College

Under Graduate

Home Address Rented, How Much? ____________________

Own - Mortgage, With ____________________

Living with Relatives

Used Free

Length of Stay _____Yrs. _____Mos.

Provincial Address

Tel. No. 1 Tel. No. 2 Mobile No. E-mail

Last Name First Name Middle Name Age Birthdate (MM/DD/YY)

Home Address

Name of Employer/Business Business Address

Employment Status Tel. No. 1 Tel. No. 2 Position

Employed OFW

Self Employed Others ___________ No. of Years with Company:

Name of Employer/Business Business Address

Employment Status Tel. No. 1 Tel. No. 2 Position

Employed OFW

Self Employed Others ___________ No. of Years with Company :

Monthly Salary : Total Monthly Income

Spouse's Monthly Salary :

Other Monthly Income From :

Name of Children/Dependents Age School

Credit References Address & Tel. No/s. Acct No. Loan Type Mo. Amort O/S Balance

Bank / Branch Account Number

1)

2)

Bank / Branch Account Number

1)

2)

Bank / Branch Account Number

1)

2)

(For Individuals / Sole Proprietorship)

A P P L I C A N T

CO-MAKER

E M P L O Y M E N T

SPOUSE / CO-MAKER INFORMATION

TIME DEPOSIT/S AT :

CREDIT APPLICATIONCREDIT APPLICATIONCREDIT APPLICATIONCREDIT APPLICATION

P E R S O N A L & C R E D I T R E F E R E N C E S

Grade Level

SAVINGS ACCOUNT/S AT :

CURRENT ACCOUNT/S AT :

N E T I N C O M E

PRINCIPAL