BINHI MICROENTERPRISES DEVELOPMENT FOUNDATION, INC.
Espinueva Bldg., Rizal-Yacapin Sts., Cagayan de Oro City
GENERAL PURPOSE LOAN APPLICATION
Principal Forms
This is to authorize Binhi Microenterprise Dev’t Foundation, Inc. or any of its officer or representative/s to conduct PICTURE 2X2
the corresponding credit verification about my loans and deposit in your company and furnish them the data they
needed below. I /We hereby waive the benefit and the protection of the Bank Secrecy Law – 1405, Data Privacy
Act – R.A. 10173 and I undertake not to hold your Bank/Company and any of your authorized representative liable
for or on account of the disclosure of facts maintained herein.
PERSONAL INFORMATION
LAST NAME FIRST NAME MIDDLE NAME SUFFIX
BIRTH DATE AGE PLACE OF BIRTH
CITIZENSHIP CIVIL STATUS SEX LOAN PURPOSE
EMAIL ADDRESS TELEPHONE NO. CELLPHONE NO. Business Salary
HOME ADDRESS : Lot no. Blk. No. Street, Subd., Brgy., Town/City/Province
LENGTH OF STAY RENTED/BOARDING OWN HOUSE/HOME
LIVING WITH RELATIVES MORTGAGED WITH _____________________________
PRESENT ADDRESS : Lot no. Blk. No. Street, Subd., Brgy., Town/City/Province
LENGTH OF STAY
FATHER’S FULL NAME : CONTACT NO. OCCUPATION
MOTHER’S FULL NAME : CONTACT NO. OCCUPATION
PROVINCIAL ADDRESS ( PARENTS/GRANDPARENTS):
LENGTH OF STAY
IF EMPLOYED
Current/Previous Employer: Contact Person: Contact No.:
Employer Address: Position: Dep’t/Branch Assign:
Length of Service: Salary: Other Income:
Salary Payroll Schedule : If ATM payroll - Bank Name: Bank Branch/Location:
If have Checking / Saving Account: Account No.: Date Opened: Bank Status:
IF SELF EMPLOYED / BUSINESS
Name Of Business: Contact Person: Contact No.:
Nature Of Business: Position: Dep’t/Branch Assign:
Length of Operation: Gross Income: Other Income:
Name of Supplier : Contact Person: Supplier: Contact No.:
If have Checking / Saving Account: Account No.: Date Opened: Bank Status:
SPOUSE INFORMATION
LAST NAME FIRST NAME MIDDLE NAME SUFFIX
BIRTH DATE AGE PLACE OF BIRTH
CITIZENSHIP CIVIL STATUS SEX OCCUPATION
EMAIL ADDRESS TELEPHONE NO. CELLPHONE NO. Business Salary
HOME PRESENT ADDRESS : Lot no. Blk. No. Street, Subd., Brgy., Town/City/Province
FATHER’S FULL NAME : CONTACT NO. OCCUPATION
MOTHER’S FULL NAME : CONTACT NO. OCCUPATION
PROVINCIAL ADDRESS ( PARENTS/GRANDPARENTS):
LENGTH OF STAY
Children’s and Other dependent’s living with the family No. of Dependent’s
NAME Birth Date AGE SCHOOL/EMPLOYER
1.
2.
3.
4.
CERTIFICATION _____________________________________________
This is to certify that I personally examined the herein
true and correct I am satisfied that he/she voluntarily executed Applicant’s Signature Over Printed Name (with Full Middle Name)
And fully understood his/her information
NEXT PAGE AT THE BACK ( Pages 1-1)
Provide details of all personal major assets, vehicle, cars, real property and etc. Date Acquired
1.
2.
3.
Existing Liabilities/ Loans : Creditor’s Company Address and Contact no. Due Date Balance
1.
2.
3.
CO-BORROWER/CO-MAKER’S INFORMATION
NAME Birth Date AGE ADDRESSED
1.
2.
3.
PLEASE SKETCH YOUR HOME ADDRESS
PLEASE SKETCH YOUR WORKED/OFFICE ADDRESS
( Pages 2-2)
