Control No.

Please write in PRINT and use BLACK INK ONLY. If a field in not applicable, write N.A.
LOAN DETAILS
Desired Loan Amount
Desired Loan Term
Loan Application Type
Purpose of Loan
(Subject to Approval)
Weeks
New Application
Appliance
Home Improvement
Months
With Existing Loan
Balance Transfer Livelihood/Working
With Previous Loan
Education
Travel
With Previous Application Health/Hospitalization Personal
Maximum Loan Amount(100,000)
Source of Loan Application
Branch(indicate branch name)_______________
Walk In
Employee Referral
Others_______________
Agency(indicate agency name)_______________
Website
Telemarketing
Gender
Male

Title

Mr.

Mrs.

Ms.

Other Name (Alias)

Female

First Name
Middle Name
Last Name
______________________________________________________________
_____________________
Date of Bith(dd/mm/yyyy)
Place of Birth
Marital Status
Spouse Name
Spouse Working?
Single
Widowed
Yes
No
Married Separated
No. of Children _____
Mothers First Name
Middle Name
Last Name
Philippine Resident?
Nationality
No. of Dependent ____
Yes
No
SSS/GSIS

TIN

Residence Type
Owned(Not Mortgaged)
Owned(Mortgaged)
Rented

Educational Attainment
High School
College Level

Amortization/Month
Rent/Month

Years/Months at Present Address

Years_____ Months______
Personal Email

Phone 2

Mobile

Fax

Permanent Home Address(Lt/Blk., No., House/Unit No., Floor No./Bldg Name,

Subd./Compound Name, Street, City/Province,Zip Code)
Residence Contact Number
Area Code
Phone 1

Post Graduate

Used Free/Staying with Relatives

Company Provided
Others___________________________

Php__________________
Php__________________

Current Home Address(Lt/Blk., No., House/Unit No., Floor No./Bldg Name,

Subd./Compound Name, Street, City/Province,Zip Code)
Residence Contact Number
Area Code
Phone 1

College Graduate

Years/Months at Present Address

Years_____ Months______
Personal Email

Phone 2

Mobile

Fax

Previous Home Address(Lt/Blk., No., House/Unit No., Floor No./Bldg Name,

Subd./Compound Name, Street, City/Province,Zip Code)

Years/Months at Present Address

Years_____ Months______

Provincial Home Address(Lt/Blk., No., House/Unit No., Floor No./Bldg Name,

Subd./Compound Name, Street, City/Province,Zip Code)

Years/Months at Present Address

Years_____ Months______

Provincial Contact Number

Area Code
Phone 1

Personal Email
Phone 2

Mobile

Fax

Source of Income
Employment Business

Permanent?
Yes No

Nature of Business

WORK A ND FINANCES
Part Owner?
Yes
% of Ownership
No

Company Type
Private
Government

Employer/Business Name

Rank
Staff
Middle Management
Junior Officer Production Worker

Position

Service Employee(e.g., doctor, nurse, legal counsel, etc.)

President/General Manager
Senior Manager

Employer/Business Address(Lt/Blk., No., House/Unit No., Floor No./Bldg Name,

Subd./Compound Name, Street, City/Province,Zip Code)
Office Contact Number
Area Code
Phone 1

VP

Years/Months at Present Address

Years_____ Months______
Office Email

Phone 2

Mobile

Monthly Income(based on 1 month payslip)

Basic Php____________
Allowance Php____________

Fax
Monthly Household Expenses

Family Income Php___________

Previous Employer/Business Name

Previous Company Contact Number

Area Code
Phone 1

Years/Months at Previous Company

Years________ Months_________
Office Email
Phone 2

Mobile

Fax

SPOUSE DETAILS
Designation/Title/Rank

Employer Business Name

Office Contact Number
Area Code
Phone 1

Others_____________

Phone 2

Mobile

Monthly Income
Years/Months at Present Company
Years_________ Months_________

REFERENCES
Bank/Credit References
Bank Name
Branch
Account Type
Account Number
____________________
____________________
____________________
____________________
Do you have a Checking Account?
Do you have other loans?
Yes No Willing to open
Yes
No
What company? __________________________
Credit Card Owned/Other Loans
Credit Card No./PN No.
Issuers Name/
Member Since/
Card Expiry/
Card Limit/
Bank Name
Loan Granted
Loan Maturity
Loan Amount
(mm/yyyy)
(mm/yyyy)
(mm/yyyy)
____________________

__________________

___________________

_________________

__________________

____________________

___________________

___________________

_________________

__________________

____________________

___________________

___________________

_________________

__________________

Personal/Trade Reference
Name

Relationship

Landline/Mobile Number

Address

A.____________________

_________________

_______________

_______________________________________

B.____________________

_________________

_______________

_______________________________________

C.____________________

_________________

_______________

_______________________________________

D.____________________

_________________

_______________

_______________________________________

E.____________________

_________________

_______________

_______________________________________

F.____________________

_________________

________________

_______________________________________

F O R C A P I T A L U N I O N U S E O N LY
Date(dd/mm/yyy)
Application No.
Source Code
Program Name
Company Rank
Channel Code
Sales Officer
Agency Name
Agency Code
Test Program
Agent Name
Agents Code
Agents Signature
BASIC REQUIREMENTS
UNDERTAKING/AUTH ORIZATION
Completely filled out application form
I hereby certify that all information herein and all supporting
Photocopy of latest ITR/Form2316
documents submitted together with this application are true
Photocopy of ID issued by the employer with photo and signature
and correct. I hereby authorize Capital Union and/or its repLatest three (3) months payslip
resentative to verify any and all information furnished by me
Certificate of employment (for selected companies)
including previous credit transactions with other institutions.
Clearance of cancelled cards (if applicable)
In this connection, I hereby waive any and all statutory and
Other documents (that may be required from the applicant to process
regulatory provisions governing confidentiality of such inforthe loan.)
mation, whenever applicable. I truly understand that any
All application with incomplete information and lacking
misrepresentation or failure to disclose information on my
requirements will not be processed. Any alteration requires
part as required in this application may cause the disthe full signature of the applicant.
approval of my application.
Upon approval applicants will be required to issue post-dated
checks for payment. Post-dated checks should be under the name
of the borrower.
A handling fee will be charged to the borrower and will be
Automatically deducted from the loan proceeds.

Upon acceptance by Capital Union of my application, I am

legally bound by the terms and conditions laid out by
Capital Union, including but not limited to joint and several
liability for all charges, fees, and obligations incurred; and I
further agree to execute the necessary documents, as may be
Required by Capital Union.
In case of disapproval of my loan application, I understand
that Capital Union is not obliged to disclose the reason/s
for such disapproval.
I acknowledge that, once I have received the loan proceeds,
Either via Managers Check, Cash or Electronic Fund
Transfer at Capital Unions options, I am deemed to have
Fully examined the documents and have waived any and all
objections thereto.

_________________________________
Applicants Printed Name & Signature

____________
Date