NISSAN AUTOLOAN APPLICATION

PRINCIPAL APPLICANT

LAST NAME: QUIBEN

FIRST NAME: HAROLD
MIDDLE NAME: NOVERAS
AGE: 38
BIRTHDAY: 03 JANUARY 1982
PLACE OF BIRTH: MARIA AURORA, AURORA
MOTHER'S MAIDEN NAME: OFELIA PERALTA NOVERAS
DEPENDENTS: JAMES BERNARD R. QUIBEN, KHENDRA AMOR R. QUIBEN, ZOIE CAYENNE R. QUIBEN
MOBILE #: 09091660978/09957319645
MARITAL STATUS: MARRIED
ADDRESS: RIZAL ST, BRGY 3, MARIA AURORA AURORA
YEARS OF RESIDENCY: 38 YEARS
OWNED or RENT: OWNED HOUSE & LOT
TEL. #: 042-7240883
TIN # : 930-032-129
EMPLOYER/BUSINESS NAME: PHILIPPINE NATIONAL POLICE
POSITION: POLICE MASTER SARGEANT
OFFICE ADDRESS: BRGY 3, MARIA AURORA, AURORA
OFFICE TEL. #: 09506575315/09061919588
YRS IN COMPANY/BUSINESS: 13 YEARS
MONTHLY INCOME: P48,297.00
OTHER INCOME: NONE
( FOR BUSINESS ) DTI REG #: ————————————————

CO-MAKER NAME: QUIBEN

FIRST NAME: HONEYLEN
MIDDLE NAME: RINGOR
RELATIONSHIP TO APPLICANT: WIFE
MOTHER'S MAIDEN NAME: THELMA ABARABAR MANANGAN
BIRTHDAY: 21 JULY 1984
AGE: 36
PLACE OF BIRTH: UMINGAN, PANGASINAN
MOBILE #: 09770158381
TIN # :
EMPLOYER/BUSINESS NAME: PREMIER GENERAL HOSPITAL OF BALER
POSITION: STAFF NURSE
OFFICE ADDRESS: BRGY SUKLAYIN, BALER, AURORA
OFFICE TEL. #: 09288757954
MONTHLY INCOME: P25,000
YRS IN COMPANY/BUSINESS: 7 YEARS
OTHER INCOME: NONE
( FOR BUSINESS ) DTI REG. #:
DEPOSITORY BANK : CHINA BANK
Branch : BALER AURORA
ACCOUNT NUMBER: