(Date)

CREDIT INFORMATION AUTHORITY

[MUNICIPALITY OF TUMAUINI, ISABELA] hereby acknowledges that relative to its/his credit application/the
maintenance of its/his existing loan with the Development Bank of the Philippines (DBP), and pursuant to regulation
and sound credit practices, it/he understands that the conduct of background and credit checks as well as the
maintenance of records pertaining to its credit information and the personal and credit information of its principals
and Related Persons, is necessary for proper risk assessment in order to establish, among others, its/his credit
worthiness as a Borrower.

In connection with these purposes, the undersigned hereby authorizes the following:

1. DBP to obtain credit information on [MUNICIPALITY OF TUMAUINI, ISABELA], its major stockholder/s,
controlling stockholders, principals, subsidiaries/affiliates, guarantor/s, joint and several signatories and/or
third-party mortgagor/s
(collectively, the “Related Persons” listed below) from: (i) credit bureaus/reporting agencies such as, but
not limited to, the Credit Information Corporation (CIC), BAP Credit Bureau, Inc., and Credit Management
Association of the Philippines; (ii) banks and/or financing companies/institutions, (iii) other
creditors/lenders and on-line search engines;
2. DBP to regularly submit and disclose credit information on [MUNICIPALITY OF TUMAUINI, ISABELA] to the
CIC as well as any updates or corrections thereof; and
3. DBP to share credit information on [MUNICIPALITY OF TUMAUINI, ISABELA] with other creditors/lenders
and credit bureaus/credit reporting agencies.

Related Persons/Relationship to Borrower:

1.
2.
3. (Pls. add additional item no. /nos., if necessary)

This also authorizes the Credit Investigator of DBP to inquire, verify, or validate information/document on
[MUNICIPALITY OF TUMAUINI, ISABELA], its major stockholder/s, controlling stockholders, principals,
subsidiaries/affiliates, guarantor/s, joint and several signatories and/or third party mortgagor/s with the following:

1. Referred Bank/Financing Company/Creditor

Name of Bank-Branch / Amount of Loan
Name of Borrower
Financing Co./ Creditor

2. SEC/DTI/CDA, BIR, National Electrification Authority, LWUA, and other related government offices
whichever is applicable
3. Credit Bureaus & Associations and On-line search engines
4. Courts of Law
5. Trade Suppliers
6. Others
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Pursuant thereto, the undersigned acknowledges that he is informed of his rights as a data subject provided under
R.A. 10173 (Data Privacy Act of 2012) and R.A.9510 (Credit Information System Act). He further acknowledges
that he is aware that the personal and credit information DBP holds pertaining to himself and the Related Persons
will be kept in strict confidentiality, retained only for as long as the above-mentioned purposes exist in accordance
with the DBP Retention Policy and used only according to the purposes declared above.

He further acknowledges that as the authorized signatory of [MUNICIPALITY OF TUMAUINI, ISABELA]. It is his
duty and responsibility to (1) inform said Related Persons of the Purposes for which his/their Personal
Information have been submitted, collected and processed by DBP and (ii) to obtain consent from said
Related Persons for the collection, processing of his/their personal and credit information in accordance
with the Data Privacy Act of 2012 and the Credit Information System Act.

Thank you.

HON. ARNOLD S. BAUTISTA

Borrower/Authorized Signatory in
case of corporation
(Signature over printed name)