PERSONAL LOAN APPLICATION FORM(INDIVIDUAL) 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 Desired Loan Amount: P Loan Purpose: Home Improvement Travel/Vacation Tuition Fee/School Expenses Car Repair Medical/Hospital Credit Card Payment Appliance/Furniture Purchase Wedding/Special Events Business Related Others: PERSONAL INFORMATION Last Name Applicant: Status: First Name Middle Name Gender: Married Single Separated Widowed Birthdate(mm/dd/yyyy): __/__/____ Citizenship: Male No. of Dependents: Birthplace: Length of Stay: Length of Stay: Length of Stay: Age: Present Home Address: Previous Home Address: Permanent Home Address: Mailing Address: Tel. No.: TIN: Mobile No.: Email: SSS No.: GSIS No.: Present Home Ownership: Owned Rented Estimated Value: Mortgaged Estimated Value: Educational Attainment: College Highschool Type of Car/s Owned: No. of Cars Owned: Living with Relatives Bank: Balance: Post Graduate Vocational Make and Year: Do you have any relatives working at PBCOM? Exisiting PBCOM Client? Yes Yes No If Yes, Name: If Yes, type of account: No Female Relationship: Account No.: SPOUSE / CO-MAKER PERSONAL INFORMATION Last Name Spouse/ Co-Maker: First Name Middle Name Male Gender: Female If Co-Maker, relationship to borrower: Status: Single Separated Married Widowed 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: No. of Dependents: Age: Birthplace: Length of Stay: Length of Stay: Length of Stay: Account No.: SOURCE OF FUNDS Applicant Employed Private Self Employed Retired Government Employer/Business Name: Address: Occupation: Unemployed 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 Spouse/Co-Maker Employed Private Self Employed Retired Government Employer/Business Name: Address: Occupation: Unemployed 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 REFERENCES Name Address Tel. No. Personal Trade Supplier Credit Cards Credit Card Company Bank Accounts Loans CREDIT CARDS / BANKS / FINANCING INSTITUTIONS 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. source, any credit reporting agency or any third party, for purpose of, among others, evaluating this application form, for credit reporting, and harmless from any liability that may arise from obtaining or disclosing such information. 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. 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 Bank’s 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: