3.

4.

DISCLOSURE STATEMENT OF LOAN/CREDIT TRANSACTION

(SINGLE PAYMENT OR INSTALLMENT PLAN)
(As require under R.A. 3765, Truth in Lending Act)
Name of Borrower
Address
1. Net Proceeds of Loan
2. Finance Charges
a. Interest
Simple
Compound

Php
% p. mo. From interest of Charges . . . .
Daily
Semi-Annual
Monthly
Annual
Quarterly

b.
c.
d.
e.
f.
g.

Discounts
Service/Handling Charges
Credit Investigation Fees
Appraisal Fees
Attorneys/Legal Fees
Other charges incidental to the
Extension of credit (specify)
Rebatable Prompt Payment Discount . . . . . . . . . . . . . . . . . .
Total Finance Charges
Payment
a. Single Payment due
b. Total Installment Payment

Php

(Payable in
days/weeks/months of Php
)
Additional Charges in case certain stipulations
In the contract are not met by the debtor.
Nature
Rate
1. Penalty Charges on Delayed
Installment Payment . . . . . . . . . .
% per month of the amount due
2. Attorneys Fees . . . . . . . . . . . . . .
25 % of the amount due
3. Liquidated . . . . . . . . . . . . . . . . . .
10 % of the amount due
4. Collection Fees . . . . . . . . . . . . . .
Php
per follow-up

Php

CERTIFIED CORRECT
(Signature of Creditor/Authorized Representative Over Printed Name)

MANAGER

Position

I ACKNOWLEDGE RECEIPT OF A COPY THIS STATEMENT PRIOR TO THE CONSUMMATION OF THE CREDIT
TRANSACTION AND I UNDERSTAND AND FULLY AGREE TO THE TERMS AND CONDITIONS THEREOF:

Signature of the Borrower

Signature of the Maker 2

Signature of the Maker 1

Signature of the Maker 3

Date
NOTICE THE BORROWER; YOU ARE ENTITLED TO A COPY OF THIS PAPER WHICH YOU SHALL SIGN.