1. OMIE SIMEON
Tel. #: (02)576-4578
SOURCE OF LOAN APPLICATION:
GENDER
[ ] MALE [ ] FEMALE
TITLE [ ] MR [ ] MRS [ ] MS
FIRST NAME MIDDLE NAME LAST NAME
OTHER NAME/ALIAS
DATE OF BIRTH (DD/MM/YYYY) PLACE OF BIRTH MARITAL STATUS
[ ] SINGLE [ ] WIDOWED
[ ] MARRIED [ ] SEPARATED
SPOUSE NAME SPOUSE WORKING?
[ ] YES [ ] NO
NO OF CHILDREN:
NO OF DEPENDENTS:
MOTHERS FIRST NAME MIDDLE NAME LAST NAME PHILIPPINE RESIDENT?
[ ] YES [ ] NO
NATIONALITY
SSS/GSIS NO TIN EDUCATIONAL ATTAINMENT
[ ] HIGH SCHOOL [ ] COLLEGE LEVEL [ ] COLLEGE GRADUATE [ ] POST GRADUATE
CURRENT HOME ADDRESS YEARS/MONTH AT PRESENT ADDRESS
YEARS: MONTHS:
RESIDENCE
AREA CODE
CONTACT NUMBER
PHONE 1 PHONE 2 MOBILE NUMBER PERSONAL EMAIL
RESIDENCE TYPE AT YOUR CURRENT ADDRESS
[ ] OWNED (Not Mortgaged) [ ] STAYING WITH RELATIVES
[ ] OWNED (Mortgaged) Amortization:_________ [ ] STAYING WITH PARENTS
[ ] COMPANY PROVIDED [ ] RENTED RENT/MONTH:______
PREVIOUS HOME ADDRESS :
YEARS/MONTH AT PREVIOUS ADDRESS :
PERMANENTADDRESS:
YEARS/MONTH AT PREVIOUS ADDRESS :
PROVINCIAL ADDRESS:
YEARS/MONTH AT PREVIOUS ADDRESS :
WORK AND FINANCES
SOURCE OF INCOME
[ ]EMPLOYMENT [ ]BUSINESS
PERMANENT?
[ ] YES [ ] NO
PART OWNER?
[ ]YES % OF OWNERSHIP[ ]%
[ ]NO
COMPANY TYPE
[ ]PRIVATE [ ] OTHER:
[ ] GOVERNMENT
NATURE OF BUSINESS EMPLOYER / BUSINESS NAME POSITION
RANK
[ ] STAFF [ ] MIDDLE MANAGEMENT [ ] SERVICE EMPLOYEE [ ] VICE PRESIDENT
[ ] JUNIOR OFFICER [ ] PRODUCTION WORKER [ ] PRESIDENT/GENERAL MANAGER [ ] SENIOR MANAGER
EMPLOYER BUSINESS ADDRESS YEARS/MONTHS AT THE PRESENT COMPANY
YEARS: MONTHS:
OFFICE
AREA CODE
CONTACT NUMBER
TRUNKLINE PHONE 2 MOBILE NUMBER OFFICE EMAIL
MONTHLY INCOME
BASIC PHP:[ ] ALLOWANCE: [ ] FAMILY INCOME [ ]
MONTHLY HOUSEHOLD EXPENSES
PREVIOUS EMPLOYER YEARS/MONTHS AT PREVIOUS COMPANY
YEARS: MONTHS:
OFFICE
AREA CODE
CONTACT NUMBER
PHONE 1 MOBILE NUMBER OFFICE EMAIL
DESIRED
LOANAMOUNT:
DESIRED LOAN TERM
[ ] 12 MONTHS
[ ] 18 MONTHS
[ ] 24 MONTHS
[ ] 36 MONTHS
LOAN APPLICATION TYPE
[ ] NEW APPLICATION
[ ] WITH EXISTING LOAN
[ ] WITH PREVIOUS LOAN
[ ] WITH PREVIOUS APPLICATION
PURPOSE OF LOAN
[ ] APPLIANCE [ ] HOME IMPROVEMENT
[ ] BALANCE TRANSFER [ ] LIVELIHOOD/CAPITAL
[ ] EDUCATION [ ] TRAVEL
[ ] HEALTH/HOSPITALIZATION [ ] PERSONAL

2. SPOUSE DETAILS
EMPLOYER BUSINESS NAME DESIGNATION/RANK MONTHLY INCOME
OFFICE
AREA CODE
CONTACT NUMBER
PHONE 1 PHONE 2 MOBILE NUMBER
YEARS AT THE PRESENT COMPANY
YEARS: MONTHS:
REFERENCES
BANK/CREDITREFERENCES
BANK NAME BRANCH ACCOUNTTYPE ACCOUNTNUMBER
A. ______________________________________________________________________________________
B. ______________________________________________________________________________________
CREDITCARD OWNED
CREDITCARD NO ISSUER/BANK NAME MEMBER SINCECARD EXPIRYDATE CARD LIMIT
A. ______________________________________________________________________________________
B. ______________________________________________________________________________________
PERSONAL REFERENCES
NAME RELATIONSHIP LANDLINE/MOBILE NUMBER ADDRESS
A. ______________________________________________________________________________________
B. ______________________________________________________________________________________
C. ______________________________________________________________________________________
___________________________________________________
APPLICANT PRINTED NAME & SIGNATURE
FOR BANKS USE ONLY
[ ] COMPLETELY FILLED OUTAPPLICATION FORM
[ ] PHOTOCOPY OF LATEST ITR2316
[ ] PHOTOCOPY OF COMPANY ID
[ ] LATEST ONE(3) MONTH PAYSLIP
[ ]CERTIFICATEOF EMPLOYMENT
[ ]CLEARANCEOF CANCELLED CARD (IF APPLICABLE)
NO FEES TO BE COLLECTED UPON APPLICATION
OMIE SIMEON
Tel. #: (02)576-4578