PERSONAL LOAN
APPLICATION FORM
Amount Applied For: Purpose of Loan: Term of Loan: Requirements:
12 months • Latest ITR
24 months • Latest 1 month pay slip and COE
36 months • Photocopy of a valid I.D. w/ 3 specimen signatures
• Proof of Billing
BORROWERS DATA
First Name Middle Name Last Name Marital Status: Gender:
Married Separated Male
TIN: SSS /GSIS No: Single Widowed Female
Present Address (House No, Street, Subdivision, Bldg.Name,City/Municipality) Years of Stay: Owned
_________________________________________________________________ Owned-Mortgaged
_________________________________________________________________ Home Telephone No/s: Living w/ Relatives
Permanent Address: Rented
Citizenship Birthday (dd-mm-yyyy) Age: Cellphone No: Dependents:
Birthplace:
Highest Educational Attainment: Email Address: Mother’s Full Maiden Name
High School Graduate College Undergraduate
College Graduate Post Graduate
Present Employer Private Length of Years w/ Previous Position:
Government Stay: Employer:
Office Address: (Floor, Bldg. Name, Street, City) Office Telephone No (including Status: Permanent
_________________________________________________________________ Local No.): Probationary
_________________________________________________________________ Contractual
Fax No: Email Address:
Name of Spouse (First Name, Middle Name, Last Name) Citizenship Birthday (dd-mm-yyyy) Age
Spouse's Employer Private Position Length of Stay
Government
Spouse's Employer Business Address Office Telephone No (including Cellphone No:
Local No):
CREDIT CARD
Bank Credit Card No. Credit Limit Expiry Date
BANK ACCOUNTS
Bank-Branch Type of Account Account No. Year Opened
LOANS WITH OTHER BANKS/ INSTITUTIONS
Bank/Company Outstanding Balance Monthly Amortization Loan Type
PERSONAL REFERENCES
Name Address Relationship Telephone / Cellphone No/s
INCOME & FINANCES AUTHORIZATION:
Gross Monthly Income: I hereby certify that all information I furnished in this form are true and correct. Should said
information furnished herein be found to be false, the bank may disapprove this application and/or
Applicant P declare the loan to be due and demandable (in case the loan proceeds have already been
Spouse released).
Total Premiere Development Bank and its authorized representative/s are hereby authorized to validate
the information provided in this form from our employer, personal references, banks and other such
Less: Monthly Expenses sources. Person/s identified in this form are hereby authorized to provide information/documents
_______________
Taxes, SSS & other required in connection with this application. I fully understand that loan release shall only be allowed
_______________ once all requirements of Premiere Development Bank are complied with.
deductions,
_______________ Premiere Development Bank is also hereby authorized to fill-up the necessary information
Living Expenses
_______________ required in the Promissory Note and the Disclosure Statement, both of which I have signed herein,
Rent
_______________ including the date, amount of the loan granted to me, and the interest rate in accordance with the
Education Amortization
_______________ Bank's applicable policies and the approved terms and conditions of the loan.
Credit Cards Insurance In case of disapproval of this application, I understand that the Bank is not obliged to disclose the
_______________
_______________ reason/s for such disapproval. In the event of future delinquency, I hereby authorize the Bank to
report and/or include my name in the negative listing of any credit bureau or institution.
NET INCOME P
___________________________
Name and Signature of Applicant
TO BE FILLED OUT BY REFERROR / AGENT
Date Code "PLEASE MAKE PAYMENTS ONLY TO AUTHORIZED PREMIERE BANK
Branch/Agency Name EMPLOYEES. SALES AGENTS AND/OR REFERRORS ARE NOT ALLOWED TO
Referror/Agent Name COLLECT ANY FEES OF WHATEVER NATURE ON BEHALF OF PREMIERE BANK"
