FLH060A

HDMF HOUSING LOAN APPLICATION

(For Co-Borrower/s Only)

CO-BORROWER 1
Last Name First Name Middle Name HDMF ID No. ZIP Code E-mail Address Years of Stay Company Living w/ relatives/parents Rented at /P _________/mo. EE SSS/GSIS ID No. TIN Date of Birth (mm/dd/yy) Gender M Home Tel. No. Civil Status Single Married Widow/er Legally Separated Annulled
For HDMF USE ONLY
MONTHLY HDMF CONTRIBUTION

F
ATTACH HERE 1" x 1" ID PHOTO OF APPLICANT

Permanent Home Address (No., Street, City, Municipality, Province) Present Home Address (No., Street, City, Municipality, Province) Residence Address (Abroad) Home Ownership Owned Mortgaged

Business Tel. No. Mobile Phone No.

Company/Employer/Business Name (if self-employed) Company/Employer/Business Address Nature of Business Preferred Mailing Address

P LOAN ENTITLEMENT

Years in Employment/Business Philippine Citizen? Yes Position & Department No. of Dependent/s

No

P CERTIFIED BY

SPOUSE PERSONAL DATA

Last Name First Name Middle Name Date of Birth (mm/dd/yy) TIN Company/Employer/Business Name (If self-employed) Nature of Business Position & Department Company/Employer/Business Address Business Tel. No. Years in Employment/Business

BANK ACCOUNTS (Indicate your 3 most active)

BANK BRANCH/ADDRESS TYPE OF ACCOUNT ACCOUNT NO. DATE OPENED AVE. BALANCE

CREDIT CARDS OWNED (Indicate your 3 most active)

CARD COMPANY BANK ISSUER CARD NO. EXPIRY DATE AVE. BALANCE

REAL ESTATE OWNED

LOCATION TYPE OF PROPERTY TCT NO. ACQUISITION COST MARKET VALUE MORTGAGE BALANCE RENTAL INCOME

OUTSTANDING CREDITS/LOAN AVAILMENTS

Creditor & Address Security Type Amount/Balance Creditor & Address Security Type Amount/Balance Maturity Date Mo. Amortization Maturity Date Mo. Amortization

CO-BORROWER 2
Last Name First Name Middle Name HDMF ID No. ZIP Code E-mail Address Years of Stay Company Living w/ relatives/parents Rented at /P _________/mo. EE SSS/GSIS ID No. TIN Date of Birth (mm/dd/yy) Gender M F Home Tel. No. Civil Status Single Married Widow/er Legally Separated Annulled
For HDMF USE ONLY
MONTHLY HDMF CONTRIBUTION

Permanent Home Address (No., Street, City, Municipality, Province) Present Home Address (No., Street, City, Municipality, Province) Residence Address (Abroad) Home Ownership Owned Mortgaged

ATTACH HERE 1" x 1" ID PHOTO OF APPLICANT

Business Tel. No. Mobile Phone No.

Company/Employer/Business Name (if self-employed) Company/Employer/Business Address Nature of Business Preferred Mailing Address

P LOAN ENTITLEMENT

Years in Employment/Business Philippine Citizen? Yes Position & Department No. of Dependent/s

No

P CERTIFIED BY

SPOUSE PERSONAL DATA

Last Name First Name Middle Name Date of Birth (mm/dd/yy) TIN Company/Employer/Business Name (If self-employed) Nature of Business Position & Department Company/Employer/Business Address Business Tel. No. Years in Employment/Business

BANK ACCOUNTS (Indicate your 3 most active)

BANK BRANCH/ADDRESS TYPE OF ACCOUNT ACCOUNT NO. DATE OPENED AVE. BALANCE

CREDIT CARDS OWNED (Indicate your 3 most active)

CARD COMPANY BANK ISSUER CARD NO. EXPIRY DATE AVE. BALANCE

REAL ESTATE OWNED

LOCATION TYPE OF PROPERTY TCT NO. ACQUISITION COST MARKET VALUE MORTGAGE BALANCE RENTAL INCOME

OUTSTANDING CREDITS/LOAN AVAILMENTS

Creditor & Address Security Type Amount/Balance Creditor & Address Security Type Amount/Balance Maturity Date Mo. Amortization Maturity Date Mo. Amortization

FINANCIAL INFORMATION
ASSETS AND LIABILITIES
CO-BORROWER 1 ASSETS CASH ON HAND/BANK STOCKS AND BONDS REAL ESTATE MOTOR VEHICLES OWNED OTHERS (Specify) __________________ __________________ __________________ __________________ __________________ __________________ __________________ CO-BORROWER 2 __________________ __________________ __________________ __________________ __________________ __________________ __________________ INCOME SALARIES ALLOWANCES COMMISSIONS RENTAL INCOME OTHERS (Specify)

MONTHLY INCOME AND EXPENSES

CO-BORROWER 1 __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ CO-BORROWER 2 __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

TOTAL ASSETS LIABILITIES UNSECURED LOANS OTHERS (Specify) __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

GROSS MONTHLY INCOME WITHHOLDING TAX NET MONTHLY INCOME

TOTAL LIABILITIES NET WORTH (ASSETS-LIABILITIES)

EXPENSES (Combined for Borrower/Spouse/OTHERS) Living and Utilities __________________ Education __________________ Transportation __________________ Loan Amortization __________________ Others (Specify) __________________ __________________ __________________ Monthly Expenses __________________ Net Disposable Income LOAN ENTITLEMENT

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

LOAN AND CREDIT REFERENCES

BANK/FINANCIAL INSTITUTION ADDRESS PURPOSE SECURITY HIGHEST AMOUNT OWED PRESENT BALANCE DATE OBTAINED DATE FULLY PAID

CHARACTER REFERENCES
NAME ADDRESS TEL. NO.

MISCELLANEOUS (Answer the following questions with YES or NO. If your answer is YES, please elaborate on the details as required.)

MISCELLANEOUS (Answer following questions with YES or NO. If your answer is YES, please elaborate on the details as required.) Are there past or pending cases against you? the Yes No If yes, please indicate the nature, plaintiff, amount involved and the status.
Do you have past due obligations? If yes, please indicate the creditor's name, nature, amount involved and due date. Yes No Was your bank account ever closed because of mishandling or issuance of bouncing checks? If yes, please indicate the bank's name, nature, amount and date. Yes No

CERTIFICATION
I/We certify that the foregoing information/statement are to the best of my/our knowledge, true, correct and complete, and I/We hereby agree that any misrepresentation of a material fact is a ground for disapproval of the application, cancellation of the loan, or foreclosure of the mortgage as the case may be. I/We agree to notify HDMF of any material change affecting the information contained herein. I/We agree that all information obtained by HDMF shall remain its property whether or not the loan is granted. The signature/s appearing below is/are genuine.
SIGNATURE OF CO-BORROWER SIGNATURE OF SPOUSE DATE SIGNATURE OF HDMF REPRESENTATIVE RECEIVED BY SIGNATURE OF CO-BORROWER SIGNATURE OF SPOUSE DATE NAME IN PRINT DATE RECEIVED

THIS FORM CAN BE REPRODUCED. NOT FOR SALE