CLIENT INFORMATION SHEET
✔ Business Name ✔Address
✔ Type of Loan Request ✔ Purpose of Loan ✔ Amount
BUSINESS INFORMATION
✔ Nature of [ ] Agricultural [ ] Trade [ ] Mining & Quarrying [ ] Manufacturing Industry Code:
Business: [ ] Construction [ ] Real Estate [ ] Public Utilities [ ] Services Industry Classification:
[ ] Others:
✔Telephone Nos.: ✔Fax Nos.: ✔Email Address:
✔ Contact Person/Position:
✔ Business Entity: [ ] Single Proprietorship [ ] Partnership [ ] Domestic Corporation [ ] Multinational Corporation [ ] Others: ____________
✔ Date of DTI/SEC Registration: ✔Start of Operations:
✔ Product Lines: Trade Name Trademarks/Patents Owned (if any):
Equity Capital At Inception At Present
Authorized Capital Stock
Subscribed Capital Stock
Paid-up Capital Stock
Ownership Structure Management Structure
✔ Name of Stockholder/ Owner Citizenship Birth Date % Ownership Name of Officers/ Directors Position
✔ Name of Affiliate/ Subsidiaries Address
OPERATING FACILITIES
✔ Main Office Plant/ Factory Warehouse
Location : Location : Location :
[ ] Owned [ ] Owned [ ] Owned
[ ] Mortgaged with ___________ [ ] Mortgaged with ___________ [ ] Mortgaged with ___________
[ ] Leased from _________ [ ] Leased from _________ [ ] Leased from _________
Expiry Date: ________ Mo. Rental _____ Expiry Date: ________ Mo. Rental _____ Expiry Date: ________ Mo. Rental _____
✔ Vehicles, Machinery & Equipment (Please provide separate sheet, if necessary)
Make/Model/Type No. of Units Rated Capacity Actual Output
MANPOWER COMPLEMENT
✔ ✔Contractual:
Regular: ✔No. of Shifts: Unionized: [ ] Yes [ ] No CBA [ ] None [ ] Existing/Expiry __________
DEPOSITORY BANKS/ CREDITORS
✔ Name of Bank/ Financial ✔ Type of Deposit ✔Type of Loans/ Facility/ ✔Contact Person ✔ Address/Tel./Fax Nos.
Institution/ Branch (Including Acct. No.) Amount
✔ TRADE SUPPLIERS
Name Credit Line Credit Items Purchased/ Average Contact Address/Tel./Fax
Terms Services Mo.Volume Person Nos.
✔ PRINCIPAL CUSTOMERS
Name Credit Line Credit Items Purchased/ Average Contact Address/Tel./Fax
Terms Services Mo.Volume Person Nos.
✔ __________________________ ✔ ___________________________________
Date Authorized Signature/s
BASIC INFORMATION (KEY OFFICERS/ PRINCIPALS/SURETIES)
(Please provide separate sheet for each Key Officer, if necessary)
✔ First Name Middle Name Surname
Present Address: Permanent Address:
✔
✔ Ownership: Ownership:
[ ] Owned [ ] Rented [ ] Owned [ ] Rented
[ ] Mortgaged with [ ] Free Use [ ] Mortgaged with [ ] Free Use
Length of Stay (in years): __________________ Length of Stay (in years): __________________
✔Fax: ✔Email Address:
✔ Contact Nos.
✔ Date of Birth: ✔Place of Birth ✔Gender: ✔Nationality: ✔Residency:
[ ] Male [ ] Female [ ] Resident/Citizen [ ] Non-Resident Alien
[ ] Resident Alien
✔
Civil Status: [ ] Single [ ] Married [ ] Widowed [ ] Legally Separated [ ] Separated [ ] Annulled
✔ TIN No. ✔SSS/GSIS No.
✔ Position / Years in Service ✔Annual Basic Salary ✔Other benefits/bonuses/commissions/allowances:
✔ Educational Attainment ✔School
✔ Work Experience
Company/ Address From To Position
✔ Spouse Name:
First Name Middle Name Surname
✔ Date of Birth ✔Place of Birth ✔Gender: ✔Nationality: ✔Residency:
[ ] Male [ ] Female [ ] Resident/Citizen [ ] Non-Resident Alien
[ ] Resident Alien
✔ Educational Attainment ✔School
✔ Work Experience
Company/ Address From To ✔Position
✔ Name of Child/ ren, if any ✔ Date of Birth ✔ School ✔ Course
✔ Other Real Estate Owned
✔Location ✔ ✔Type of Improvement, ✔Estimated Value
Lot Area/
Classification if any
[ ] Clean [ ] Mortgaged With
[ ] Clean [ ] Mortgaged With
[ ] Clean [ ] Mortgaged With
✔ Vehicles Owned
✔Year/ Make/ Model ✔ Estimated Value
[ ] Clean [ ] Mortgaged With
[ ] Clean [ ] Mortgaged With
[ ] Clean [ ] Mortgaged With
✔ Other Properties Owned
✔ Details ✔ Estimated Value
[ ] Clean [ ] Mortgaged With
[ ] Clean [ ] Mortgaged With
[ ] Clean [ ] Mortgaged With
DEPOSITORY BANKS/ CREDITORS/ CREDIT CARD
✔ Name of Bank/ Branch/ Financial ✔ Type of Deposit ✔ Type of Loans/ Facility/ ✔ Contact Person ✔ Address/Tel./Fax Nos.
Institution/ Credit Card (Including Acct. No.) Amount
I / We certify that all information given above are true and correct to the best of my knowledge. The above information are given for
the purpose of obtaining credit from and hereby authorize SBM LEASING, INC., to obtain information concerning any statement
made herein. Pursuant to Bangko Sentral ng Pilipinas (BSP) circular 472 dated February 1, 2005. I / We hereby execute a Waiver of
Confidentiality of Information authorizing SBM LEASING, Inc. to conduct random verification with the Bureau of Internal Revenue
(BIR) for purposes of establishing the authenticity of the Income Tax Return (ITR) and accompanying financial statements submitted
by us in connection with loans, other credit accommodations and credit lines granted, renewed or extended by the said financial
institution.
✔ __________________________ ✔ ___________________________________
Date Authorized Signature/s
