THE COUNTRY BANK

Rural Bank of Bongabong (Or. Mindoro) Inc.

ROXAS BRANCH
LOAN APPLICATION FORM
(FOR S.H.E.L.Ter LOAN)
Instruction: To ensure fast and efficient processing of your loan, be sure that all the blanks in this application form are filled-up properly. If in
doubt of any of the questions, you may ask the LOAN SPECIALIST or any THE COUNTRY BANK representative to assist you.

LOAN REQUESTED TERM OF LOAN PURPOSE OF LOAN DATE

BORROWER’S NAME Height: Weight:

Date of Birth:
Place of Birth:
(Last name) (First name) (Middle name) Age:
Civil Status: Single Married Separated Widowed Contact Number:
Number in the FAMILY DEPENDENTS
Name Age School Grade level

Provincial Address: Tel. No.:

No. of Years in this Address: Owned Rented Living w/ Parents or Relatives
Educational Attainment: Name of School Year Graduated Degree/Title
Elementray:
High School:
College/Vocational:
Post Graduate:
BUSINESS OR EMPLOYER’S NAME:
Office Address: Tel. No.:
Kind of Business: Position: Length of Service
SPOUSE:
Name: Date of Birth : Age: Place of Birth:
Employer/ Business Name: Position: Length of Service:
Employer/ Business Address
OTHER PROPERTIES OWNED BY THE BORROWER
A. HOUSE B. MOTOR VEHICLES Brand:
Type: Unit: Type:
C. LAND
Description Classification Location of Property Area Description of Improvements

AGREEMENT
'I/we affirm that each of the statement made in this application is true and correct and agree to notify the Bank of any material change affecting the
information herein. I/We authorize you to obtain, verify and investigate such information as may be required covering this application from the above references
or any other sources. I/We agree that all information obtained by THE COUNTRY BANK (Rural Bank of Bongabong),Inc., shall remain its property whether or not
the loan is granted. Furthermore, I/WE AM/ARE AWARE THAT TO USE THE PROCEEDS OF THIS LOAN TO PURPOSE OTHER THAN THOSE INDICATED HEREIN IS
“UNLAWFUL” otherwise the Bank may declare the Secured Obligations Immediately “due and demandable”.

Signature/Thumbmark of the BORROWER Signature/Thumbmark of CO-BORROWER

Signature/Thumbmark of the BORROWER Signature/Thumbmark of CO-BORROWER

ACTION ON LOAN APPLICATION

FOR BANK USE ONLY:
Date of Approval: Approved for: Php.

Main Branch Manager/ OIC Loan Specialist

MELVIN H. ALINIO GERARDO E. LIWANAG

Chief Operating Officer Member

JESSICA E. LIWANAG Dr. EDGARDO N. HERNANDEZ

Member Chairman