QUICKLEND FINANCING CO.

INC
APPLICATION FORM
LOAN INFORMATION
Amount Applied for :________________Date : _________ Bank Information:
__________________
Terms : 6 12 New Client Reloan
Bank
Mode of Payment : Monthly Semi– Monthly __________________ 2x2
Branch
Payroll Details: PHOTO
__________________
Basic Salary : _________________ Gross :_____________ ATM card No.
Cut Off Date (s) : ________ Payroll Date : ____________ __________________
SSS No: ___________________ TIN No. ______________ Account No.
PERSONAL INFORMATION
Name : _________________________________________________Birthday :______________ Age: ____Sex :____
Cellphone no : __________________________________________ E-mail Address: __________________________
Civil Status : Single Married Separated Widowed
Permanent address : ______________________________________________________________________________
Owned Rented/Mo. P___________ Free use Length of Stay _________ Tel. No. _____________
Provincial Address : _____________________________________________________________________________
Owned Rented/Mo. P___________ Free use Length of Stay _________ Tel. No. ______________

WORK INFORMATION
Employer / Business Name : _______________________________________________ length of Stay ____________
Employer Business Address : ____________________________________________ Contact No. ________________
HR Contact Person /Nos. : ______________________________________ Website : __________________________
Employment Status : Contractual Permanent Position: ______________ Monthly Salary: _____________
Previous Employer :_________________________________________________ length of Stay _________________

SPOUSE’S INFORMATION

Name : _________________________________________________Birthday :______________ Age: ____Sex :____

Cellphone no : __________________________________________ E-mail Address: __________________________
Permanent address : ______________________________________________________________________________

CO-MAKER’S INFORMATION
Name : _________________________________________________Birthday :______________ Age: ____Sex :____
Cellphone no : __________________________________________ E-mail Address: __________________________
Civil Status : Single Married Separated Widowed
Permanent address : ______________________________________________________________________________
Owned Rented/Mo. P___________ Free use Length of Stay _________ Tel. No. _____________
Provincial Address : _____________________________________________________________________________
Owned Rented/Mo. P___________ Free use Length of Stay _________ Tel. No. ______________
Payroll Details: Bank Information:
Basic Salary : ___________ Gross :_____________ Bank : _______________ Branch : _______________
Cut Off Date (s) : ________ Payroll Date : ______ ATM Card No. : ______________________________
SSS No: ___________________ TIN No. ______________ Account No : ________________________________

PERSONAL CHARACTER REFERENCES I /We hereby certify that all information provided are true and correct to the
Name: _______________________________________ best of my knowledge.
Address : ____________________________________
Company : ____________________Tel. No. ________
_____________________ _______________________ _____________
Name: _______________________________________ Principal Borrower Spouse/Co-maker Signature Date
Address : ____________________________________ (Signature over printed name) (Signature over printed name)
Company : ____________________Tel. No. ________