PERSONAL LOAN APPLICATION FORM

DSA: Agent:

Code: Code:

Branch: Others:

Code: RM/AO: Promo/Program Code:

Code:

Note: Please print legibly. If field not applicable, please write N.A. Processing of application will start only upon submission of all required documents.

LOAN INFORMATION
Loan Purpose:
Home Improvement Car Repair Travel/Vacation Medical/Hospital Tuition Fee/School Expenses Credit Card Payment Wedding/Special Events Business Related 12 Months 18 Months 24 Months 36 Months Appliance/Furniture Purchase Others: 48 Months

Desired Loan Amount: P Release of Loan Proceeds:

Cash Managers Check (subject to applicable fees)

Preferred Loan Term:

Deposit to PBCOM Account No.:

Deposit to Other Bank Account (subject to applicable fees) Bank & Branch: Account No.:

PERSONAL INFORMATION
Last Name Applicant: Status: Married First Name Middle Name Gender: Age: Male Female No. of Dependents: Birthplace: Length of Stay: Length of Stay: Length of Stay:

Single Separated Widowed Citizenship: Birthdate(mm/dd/yyyy): __/__/____ Present Home Address: Previous Home Address: Permanent Home Address: Mailing Address: Mothers Maiden Name: Tel. No.: Email: Mobile No.: TIN: GSIS No.: SSS No.: Present Home Ownership: Owned Estimated Value: Mortgaged Estimated Value: Educational Attainment: No. of Cars Owned: Exisiting PBCOM Client? Spouse/ Co-Maker: Status: Single Yes Highschool College Type of Car/s Owned: No Yes No If Yes, Name: If Yes, type of account: First Name

Rented Balance: Vocational

Living with Relatives Bank: Make and Year: Relationship: Account No.:

Post Graduate

Do you have any relatives working at PBCOM?

SPOUSE / CO-MAKER PERSONAL INFORMATION

Last Name Middle Name Gender: Married Separated Widowed Age: Male Female

If Co-Maker, relationship to borrower: No. of Dependents: Birthplace: Length of Stay: Length of Stay: Length of Stay: Citizenship: Birthdate(mm/dd/yyyy): __/__/____ Present Home Address: Previous Home Address: Permanent Home Address: Tel. No.: Email: Mobile No.: TIN: GSIS No.: SSS No.: Exisiting PBCOM Client? Yes No If Yes, type of account: Applicant Employed Private Government Employer/Business Name: Address: Occupation: Self Employed Retired Unemployed

Account No.:

SOURCE OF FUNDS

Spouse/Co-Maker Employed Private

Self Employed Retired Unemployed

Position:

Government Employer/Business Name: Address: Occupation:

Position:

Nature of Work/Business: Tel. No.: Tenure: Previous Employer: Total No. of Years Working: Gross Monthly Income: Monthly Living Expense: Other Income Source: Investments Family Business

Pension Other

Nature of Work/Business: Tel. No.: Tenure: Previous Employer: Total No. of Years Working: Gross Monthly Income: Monthly Living Expense: Other Income Source: Investments Family Business

Pension Other

REFERENCES
Name Personal Trade Supplier Address Tel. No.

CREDIT CARDS / BANKS / FINANCING INSTITUTIONS

Credit Card Company Card Number Credit Limit Outstanding Balance Member Since

Bank/Branch

Account Type

Account Number

Current Balance

Creditor

Loan Type

Current Balance

Monthly Amortization

DECLARATION I/We warrant that all information provided in this application form are true and correct. I/We agree that any material misrepresentation or falsity can be used by Philippine Bank of Communications (PBCOM) to pursue civil and/or criminal liabilities against me/us. I/We understand that PBCOM may, at its sole discretion, deny this application and further agree that PBCOM has no obligation to notify and furnish me/us the reason for such denial. Furthermore, I/we agree that all information obtained by PBCOM shall remain its property whether or not the application is granted. I/We authorize PBCOM to obtain and disclose information about me/us from and to any branch or affiliate of PBCOM, any reference source, any credit reporting agency or any third party, for purpose of, among others, evaluating this application form, for credit reporting, verification, and other risk management or regulatory requirements. I/we confirm and acknowledge that I/we shall hold PBCOM free and harmless from any liability that may arise from obtaining or disclosing such information. I/We authorize PBCOM to conduct verification with the Bureau of Internal Revenue (BIR) in order to establish the authenticity of my latest ITR and other accompanying financial statements submitted by me/us to PBCOM. I/We understand that if approved, the documentary stamp taxes, processing fees and such other fees as may be charged by PBCOM in connection with the loan shall be for my/our account. I/We hereby confirm that I/We have read, understood and agreed to all the stipulations herein stated.

Signature of Borrower over Printed Name Date:

Signature of Spouse/Co-Maker over Printed Name Date:

DISCLOSURE OF INTEREST RATES, FEES & CHARGES

* Interest rates and charges are subject to change without prior notice. All applications will be subject to the Banks credit policies and procedures.

INSURANCE (OPTIONAL) I would like more information on the Credit Life Insurance Product once my loan application has been approved. The Credit Life Insurance will cover the unpaid balance of the loan in the event of my untimely death. I further understand that the Credit Life Insurance Product is optional and has no bearing on the granting of the loan.

Signature of Borrower over Printed Name Date: