Client ID Number:

Kindly accomplish with accurate and latest information, using block letters. Do not leave any field blank. Indicate N/A if not applicable Date: ________________
Name: Business / Trade Name: (no acronym or abbreviation) □ Update
□ New
Application for: Purpose:
□ Lease □ ACL □ Receivable Discounting Others: __________________ □ Augment Permanent Working Capital □ Finance/Lease Equipment/Machineries/Vehicles
□ Amount: ____________ Term: ______________ □ ROPA Buyer/SCR □ Re-finance existing equipment/machineries/vehicles Others: ______________________________________

I. PERSONAL INFORMATION
Last Name First Name Complete Middle Name Title After Name
□ Jr. □ Sr. □ III □ IV □V □ Others: ____
□ Borrower □ Lessor □ Buyer □ Authorized Signatory □ Surety
□ Beneficial Owner □ 3rd Party Mortgagor □ Officer/Stockholder □ Others: ___________________________________________________________
Legal Aliases (Please provide court documents) Gender Birthdate (mm-dd-yyyy) Place of Birth
□ Male □ Female
Nationality Citizenship: □ If not a Filipino Citizen
□ Filipino □ Filipino ⃝ Resident ACR ___________________________ Expiry Date _______________
□ Others _________________ □ Dual Citizen _________________ ⃝ Non-Resident
Civil Status □ Single □ Married □ Widower/Widow Highest Educational Attainment
□ Divorced/Annulled □ Legally Separated □ Elementary □ High School □ College □ Masters/PhD □ No Formal Schooling
Tax Identification Number □ Without TIN Reason for no TIN: □ Homemaker □ Student □ Non-Filer

□SSS _________________ □GSIS __________________ □ Without SSS/GSIS Reason for no SSS/GSIS: □ Homemaker □ Student □ Non-Filer

PARENT / CHILDREN INFORMATION

Parent Last Name First Name Middle Name
Mother’s Maiden Name
Father’s Name
Name of Children (use separate sheet if necessary) No. of Children: _______________
1. ________________________________________________________ 3. _________________________________________________________
2. ________________________________________________________ 4. _________________________________________________________
II. CONTACT INFORMATION
PRESENT ADDRESS
Present Address: Length of Stay

No./Street/Barangay/Village Town/Municipality City/Province Country Zip Code ______ Years _____Months

Home Ownership: □ Owned □ Owned by Parents □ Rented □ Mortgaged □ Others: _________________________________________________
Telephone Number/s Mobile Phone Number/s Fax Number/s Email Address

PERMANENT ADDRESS
Permanent Address: □ Same as above Length of Stay

No./Street/Barangay/Village Town/Municipality City/Province Country Zip Code ______ Years _____Months

Home Ownership: □ Owned □ Owned by Parents □ Rented □ Mortgaged □ Others: _________________________________________________
Telephone Number/s Mobile Phone Number/s Fax Number/s Email Address

III. EMPLOYMENT INFORMATION

Sources of Funds (Choose all that apply)
□ Salary □ Personal Savings □ Inheritance □ Investment □ Remittances □ Commissions/Incentives □ Business
□ Part Time Job □ Pension/Retirement Others: _______________________________________________________________
Employment Status Job Title/Occupation/Profession: Date of Employment
□ Employed □ Self Employed □ Unemployed
□ OFW □ Retired □ Homemaker Gov’t Position:
Name of Employer/Company Nature of Business

Employer’s Address Telephone Number Fax Number

No./Street/Barangay/Village Town/Municipality City/Province Zip Code

1. Name of Business Nature of Business

Business Address Telephone Number Fax Number

No./Street/Barangay/Village Town/Municipality City/Province Zip Code

2. Name of Business Nature of Business

Business Address Telephone Number Fax Number

No./Street/Barangay/Village Town/Municipality City/Province Zip Code

GROSS ANNUAL SALARY / INCOME (in peso or peso equivalent)
□ 500,000 and up □ 1,000,000 and up □ 1,500,000 and up □ 2,000,000 and up □ 2,500,000 and up □ 3,000,000 and up □ 4,000,000 and up
IV. OTHER INFORMATION
A. REFERENCE BANKS (List down starting from most preferred to least preferred bank)
Name of Bank/Branch Type of Account Average Daily Balances

Page 1 of 2
 B. CREDIT LINES / LOANS
Lending Bank/Institution Type of Loan Credit Line Amount Outstanding Balance Collateral

C. OTHER COMPANIES OWNED/WITH SHAREHOLDINGS OR IS AN OFFICER

Name Position % of Ownership

D. RELATIVES WITH ULFC / UCPB GROUP

Name Company/Position Relationship

E. BENEFICIAL OWNER (Submit Separate CIS)

Name Relationship to Borrower Contact Number/s

F. FOR COVERED PERSON (under R.A. No. 9160 “Anti-Money Laundering Act of 2001” as amended by R.A. Nos. 9194 and □ Yes □ No
10365 (e.g. Banks, Non-Banks Financial Institution, lending companies, service providers etc.)
a. Registered with Anti-Money Laundering Council (AMLC)? □ Yes □ No-Target date to register ________________
If YES b. Do you have manual on anti-money laundering or money laundering prevention program? □ Yes □ No-Target date to comply ________________
c. Do you report covered transactions or suspicious transactions to AMLC? □ Yes □ No-Reason: ____________________________
Note: COVERED PERSON maybe natural or juridical refers to:
(1) Bank, non-banks, trust entities, foreign exchange dealers, pawnshops, money changers, remittance and transfer companies supervised by Banko Sentral ng Pilipinas (BSP);
(2) Insurance companies, pre-need companies supervised by Insurance Commission (IC).
(3) Securities dealers, brokers, salesmen, investment houses, mutual funds, close-end investment companies, common trust funds, other entities administering or otherwise dealing in
currency, commodities or financial derivatives based thereon, valuable objects, cash substitutes and other similar monetary instruments or property supervised by Securities and Exchange
Commission (SEC); (4) Jewelry dealers in precious metals and stones, who, as a business, trade in precious metals and stone, for transactions in excess of One million pesos (P1,000,000.00);
(5) Company service providers which: act as agent of juridical persons or acting as nominee shareholder or director/corporate secretary of juridical persons, and
(6) Persons who provide registered/administrative business address or accommodation for juridical/legal persons.
V. CERTIFICATION
By signing below, I/we hereby certify and attest to the fact that all the information represented and
given by me/us is/are true and correct and that any and all material misrepresentation or falsify therein
shall be construed as an act to defraud UCPB Leasing and Finance Corporation (ULFC) for which civil
and/or criminal liability can be pursued against me/us. Any changes in the foregoing information shall be
promptly communicated to ULFC. I/we hereby authorize ULFC to verify and investigate any and all
information given by me/us as ULFC may deem appropriate.

I further certify that I have read and understand the features, terms and conditions of the credit
facility/ies.
SIGNATURE OF AUTHORIZED SIGNATORIES OVER PRINTED NAME

__________________________________________________________________ _________________________________________________________

FOR ULFC USE ONLY

IDENTIFICATION CARDS PRESENTED AND ISSUE DETAILS
Type of ID ID Number Expiration Type of ID ID Number Expiration
□ Driver’s License □ DSWD Certification
□ Passport Issued by: □ NBI or Police Clearance
□ PRC ID □ TIN ID
□ Postal ID □ GSIS e-Card / SSS Card
□ Voter’s ID □ OWWA ID
□ Barangay Certification with picture □ Seaman’s Book
□ Senior Citizen ID □ GOCC ID (AFP ID, HDMF ID, etc.)
□ Company ID (registered with or □ National Council for the Welfare of Disabled Person
supervised/regulated by BSP, SEC and IC) Certification/ID Card
□ OFW ID □ PhilHealth ID
□ UMID □ School ID (Non-voting/Minor age student)
For Resident Alien SOLE PROPRIETOR
□ DTI
□ ACR □ SRRV □ SRIV □ SBMA/CDC ID □ Affidavit of Sole Proprietorship
□ Other IDs: __________________________________________________ □ Affidavit of: ________________________________
_____________________________________________________________ ____________________________________________
Checked By: Approved By:

_________________________________________ __________________________________________
Signature over Printed Name / Date Signature over Printed Name / Date
INFORMATION UPDATE
Other Documents / Information Date Updated / Source Updated By

Revised CISAF-I 07.07.2017 4:305pm