Sourcing Data:
PERSONAL REFERENCES
SPOUSE INFORMATION
Channel Source:
Source Code: _____________________________________________
Referror / Account Officer / DSA: ______________________________________________________________
APPLICATIONS WITH INCOMPLETE DOCUMENTS AND INFORMATION WILL NOT BE PROCESSED.
Mr.
Spouse:
Name:
First
Mrs.
Middle
Date of Birth (mm/dd/yyyy):
PERSONAL LOAN DETAILS
With previous or existing Security Bank Personal Loan?
Desired Loan Amount
Yes
12
PHP
Loan Purpose:
Appliance
18
Tuition Fees
24
36
Relationship
Telephone No.
College
Others: __________________
Business / Employer:
Payment term (Months)
Address
2.
Educational Attainment:
High School
Vocational
Post Graduate
No
Name
1.
Last
Position:
CREDIT CARD DETAILS
Business / Employer Address (Floor, Street, Brgy./Village, Subdivision, City/Municipality, Province):
Zip Code:
Credit Card
1.
Credit Limit
Card No.
Expiry Date
Personal Consumption
Others: ____________________________
2.
Mode of Loan Release:
Via Managers Check
Credit to my Security Bank Account:
Office Phone No.:
Branch: _____________________________
Number of Dependents:
Children:
Account Type: ____________________________
Others:
(Relationship:________________)
MY WORK AND FINANCES
Acct. No.
Employment Type:
Position:
PERSONAL INFORMATION
Title:
Name:
First
Mr.
Mrs.
Rank and File
Government
Private
Junior Officer
Ms.
Gender:
Middle
Bank / Company
1.
Self-Employed
Supervisor
Assistant Manager / Senior Assistant Manager
Manager / Senior Manager
Permanent:
Y
N
Assistant Vice President / Senior Assistant Vice President
Last
Civil Status:
Educational Attainment:
Car Ownership:
Home Ownership:
Single
Legally Separated
Married
Annulled
Date of Birth (mm/dd/yyyy):
Citizenship:
High School
Vocational
Others: __________________
College
Personal, monthly amortization (PHP ____________)
Company Provided
Both
None
Owned
Living with relatives
Rented, PHP______________/mo.
Mortgage
Length of Stay: __________ years
Company-Owned
Present Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province)*:
Date of Hire:
Length of Service:
TIN:
SSS/GSIS/UNIFIED ID Number:
Business / Employer:
Business / Employer Address (Floor, Street, Brgy./Village, Subdivision, City/Municipality, Province):
Mobile Phone No.:
Zip Code:
Zip Code:
Office Phone No.:
Home Phone No.:
Fax No.:
Best Time / Day to Call:
E-mail Address:
Gross Monthly Income:
Telephone No.:
Immediate Supervisor / HR Contact Person:
Permanent Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province)*:
Type of Loan
Monthly Payment
2.
UNDERTAKING
Nature of Business:
Widow/Widower
Place of Birth:
Post Graduate
Outstanding Balance
Vice President / First Vice President / Senior Vice President / Executive Vice President
President / Chief Executive Officer / Director / Chairman
Mothers Maiden Name
OTHER LOAN ACCOUNTS
Zip Code:
I hereby certify that all information herein are true and correct based on my own knowledge and further authorize
the Bank to obtain information as it may require concerning my loan application and agree that it shall remain the
Banks property whether my loan is approved or not. Any information given by me or other persons I authorized
which is not true or accurate, will automatically cause the Bank to reject my loan or cancel its approval.
I hereby willingly, voluntarily, and with full knowledge of my right under the law, waive the right to confidentiality
of information and authorize the Bank to disclose, divulge and reveal any such information relating to the account of
the Borrower/Mortgagor, including events of default, for the purpose of, among others, client evaluation, credit
reporting or verification and recovery of the obligation due and payable to the Bank under the terms and conditions
of this agreement.
In view of the foregoing, the Bank may disclose, divulge and reveal the aforementioned information to third
parties, including but not limited to my employer, the Banks affiliates, subsidiaries, agents or services providers, the
Bankers Association of the Philippines Credit Bureau (BAP CB) or to any similar central monitoring entity or
recipients as provided for by law and required by competent authority.
I further authorize the Bank, as my Attorney-in-Fact, to conduct random verification with the Bureau of Internal
Revenue (the "BIR") in order to establish the authenticity of my Tax Statements (the "ITR) and the accompanying
financial statements/documents submitted to the Bank in accordance with banking regulatory requirements.
I hold the Bank free and harmless from any and all liabilities, claims and demands of whatever kind or nature in
connection with or arising from the aforementioned disclosure or reporting.
I hereby acknowledge that the Personal Loan or any part(s) thereof shall be deemed to have been availed on
the date when the funds are transferred to my bank account maintained with the Bank, or upon receipt of the
Managers Check, reflecting the amount of the loan less the applicable fees, charges and taxes.
I further authorize the Bank to deduct from my Loan proceeds all fees including, but not limited to, processing
fees, documentary stamp tax, notarial fees and interest accruals should the first due date be over 30 days from the
release of my loan and other related charges.
I likewise authorize the Bank to provide me with a consumer loan or additional bank product/s (such as but not
limited to auto, housing, credit card and other products suited to my situation) at the Banks sole discretion. My
acceptance of the credit card or the proceeds of any loan released pursuant thereto shall be conclusive proof of my
acknowledgement of my additional obligations and/or indebtedness to the Bank under the Terms and Conditions set
forth by the Bank and prevailing at the time the credit card is issued or the additional loan is approved.
I hereby agree that the Bank has the right to approve a lower amount than my desired loan amount as indicated
in this application and shall render the Bank free and harmless from any liability arising thereof.
I hereby agree that should my application be denied, the Bank has no obligation to furnish the reason for such
rejection or to return my application and other submitted documents.
I also legally bind myself to the Terms and Conditions of the Loan Program Promissory Note, Disclosure
Statement and other relevant documents that I shall execute in favor of the Bank.
Name of Previous Employer:
Previous Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province)*:
Borrower's Signature Above Printed Name
Zip Code:
FOR BANKS USE ONLY
Length of Service:
Preferred Billing / Mailing Address:
Home
Business / Employer
Total Years at Work / in Business:
Date
