Appendix 16
\FORMAT OF DISCLOSURE STATEMENT ON SMALL BUSINESS/RETAIL/CONSUMER
CREDIT(Appendix to Sec. 306 on Information to be Disclosed)
____________________________________
(Business Name of Creditor)
DISCLOSURE STATEMENT ON LOAN/CREDIT TRANSACTION
(As Required under R.A. No. 3765, Truth in Lending Act)
NAME OF BORROWER _____________________________________
ADDRESS_________________________________________________
1. LOAN AMOUNT P XXX
2. OTHER BANK CHARGES/DEDUCTIONS COLLECTED1 P XXX
a. Documentary/Science Stamps P __________
b. Mandatory Credit Insurance __________
c. Others (Specify) __________
3. NET PROCEEDS OF LOAN (Item 1 less Items 2 and 3) P XXX
4. SCHEDULE OF PAYMENTS
a. Single payment due on date P XXX
b. Installment Payments (Please see attached amortization schedule)
5. EFFECTIVE INTEREST RATE (Interest and Other Charges) XXX%
Explanation: The effective interest rate is higher than the contractual interest
rate of % because of Item 2 deductions above.
6. CONDITIONAL CHARGES THAT MAY BE IMPOSED (if applicable). Please specify manner of imposition:
a. Late Charge P __________
b. Prepayment (penalty/refund) __________
c. Others (Specify) __________
___________________ __________
CERTIFIED CORRECT:
________________________________________ ________________________________________
(Signature of Creditor/Authorized Position
Representative Over Printed Name)
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Appendix 16
I ACKNOWLEDGE RECEIPT OF A COPY OF THIS STATEMENT PRIOR TO THE CONSUMMATION
OF THE CREDIT TRANSACTION
________________________________________ ________________________________________
(Signature of Borrower over Date
Printed Name)
__________________________________________________________________________
AMORTIZATION SCHEDULE
(Sample Only)
Installment (A) Loan (B) Principal (C) Interest (D) Total (E) O/SBalance
(F)
xxx xxx
1 xxx xxx xxx xxx
2 xxx xxx xxx xxx
3 xxx xxx xxx xxx
4 xxx xxx xxx xxx
5 xxx xxx xxx xxx
6 xxx xxx xxx xxx
7 xxx xxx xxx xxx
8 xxx xxx xxx xxx
9 xxx xxx xxx xxx
10 xxx xxx xxx xxx
11 xxx xxx xxx xxx
12 xxx xxx xxx xxx
Total xxx xxx xxx
Legends:
A – Number of installment periods based on loan term
B – Gross amount of loan
C – Installment payment on the principal
D – Installment payment on the interest
E – Total amortization payment for the installment period
F – Outstanding principal balance of the loan
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Appendix 16
Footnotes
1. Notes
Itemize all charges including advance deductions
– Small business/Retail/Consumer Loans includes microfinance, auto (motor), salary, personal, medical,
educational and other loans of similar nature
– This document contains the minimum information required to be disclosed to the borrower and may be
enhanced to improve client information
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