Nature of Business: Gross Annual Income:

PERSONAL LOAN APPLICATION FORM Laundry Services 4.8M

BANK INFORMATION Date Hired: Length of Service:
Are you currently a Security Bank Depositor? Account No.: Branch: 3 years
✔ Yes No 0000011255848 Anonas TIN: SSS/GSIS/UNIFIED ID Number:
Is your Payroll with Security Bank? Account No.: Branch: 226-490-946-000 33-8815737-1
Yes ✔ No
Business / Employer
PERSONAL LOAN DETAILS Time-saver Laundromat
With previous or existing Security Bank Personal Loan? Desired Loan Amount
Business / Employer Address(Floor, Street, Brgy./Village, Subdivision, City/Municipality, Province) Zip Code:
Yes ✔ No PHP 1 0 0 k
Payment term (Months) Loan Purpose:
12 18 Appliance Tuition Fees
47 Malumanay St. Teachers Village West, Quezon City 1101
Motor Vehicle Purchase
✔ 24 36 Personal Consumption Others: _________________________
Direct Office Phone No.: Alternate No.:
Mode of Loan Release: 779421266
Via Manager’s Check ✔ Credit to my Security Bank Account: Best Time / Day to Call: E-mail Address:
Branch: Account Type:
Anonas All Access
Immediate Supervisor / HR Contact Person:
Acct. No.
0 0 0 0 0 1 1 2 5 5 8 4 8
HR Contact No.: HR Email Address:
PERSONAL INFORMATION
Complete Name (First, Middle, Last)
Previous Employer:
Edward Quinones Obina
Mother’s Maiden Name
Length of Service: Total Years at Work / in Business:
Raymunda Anay Quinones
Civil Status: Gender:
Single ✔ Married Widow/Widower ✔ Male PERSONAL REFERENCES
Name Address Relationship Telephone No.:
Legally Separated Annulled Female 1.
Citizenship: Date of Birth (mm/dd/yyyy) Place of Birth:
Filipino 10/24/1981 Quezon City
Educational Attainment: 2.

High School Vocational ✔ College Post Graduate Others:____________

Car Ownership: CREDIT CARD DETAILS
Personal, monthly amortization (PHP ____________) Company Provided Both Credit Card Credit Limit Card No.: Expiry Date
1.
Home Ownership: None
Owned Living with relatives Mortgaged
Security Bank 55,000 5181780000813516 04/23
✔

Company-owned Rented, PHP__________/mo. 16

Length of Stay: _______ years 2.
Present Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province) Zip Code: Metrobank 77,00 5464985177970324 07/24
41-B Mapagkumbaba St. Sikatuna Village, Quezon City 1101 OTHER LOAN ACCOUNTS
Bank / Company Outstanding Balance Type of Loan Monthly Payment
Home Phone No.: Mobile Phone No.: E-mail Address:
1.
09159765935 edwardobina@yahoo.com
Permanent Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province) Zip Code:
2.
Same as above
Previous Home Address (No., Street, Brgy./Village, Subdivision, City/Municipality, Province) Zip Code:
UNDERTAKING
I hereby certify that all information herein are true and correct based on my own knowledge and further authorize the Bank to
obtain information as it may require concerning my loan application and agree that it shall remain the Bank’s property whether my
loan is approved or not. Any information given by me or other persons I authorized which is not true or accurate, will automatically
cause the Bank to reject my loan or cancel its approval.
Preferred Billing / Mailing Address: I hereby willingly, voluntarily, and with full knowledge of my right under the law, waive the right to confidentiality of information
and authorize the Bank to disclose, divulge and reveal any such information relating to the account of the Borrower/Mortgagor,
Home ✔ Business / Employer including events of default, for the purpose of, among others, client evaluation, credit reporting or verification and recovery of the
obligation due and payable to the Bank under the terms and conditions of this agreement.
In view of the foregoing, the Bank may disclose, divulge and reveal the aforementioned information to third parties, including but
SPOUSE INFORMATION not limited to my employer, the Bank’s affiliates, subsidiaries, agents or service providers, the Bankers’ Association of the Philippines
– Credit Bureau (BAP – CB) or to any similar central monitoring entity or recipients as provided for by law and required by competent
Complete Name (First, Middle, Last) Date of Birth (mm/dd/yyyy) authority.
I further authorize the Bank, as my Attorney-in-Fact, to conduct random verification with the Bureau of Internal Revenue (the
Arivle Anataliio Obina 05/11/1979 "BIR") in order to establish the authenticity of my Tax Statements (the "ITR”) and the accompanying financial statements/documents
submitted to the BANK in accordance with banking regulatory requirements.
Are you currently a Security Bank Depositor? Account No.: Branch: I hold the Bank free and harmless from any and all liabilities, claims and demands of whatever kind or nature in connection with
or arising from the aforementioned disclosure or reporting.
Yes ✔ No I hereby acknowledge that the Personal Loan or any part(s) thereof shall be deemed to have been availed on the date when the
funds are transferred to my bank account maintained with the Bank, or upon receipt of the Manager’s Check, reflecting the amount
Is your Payroll with Security Bank? Account No.: Branch: of the loan less the applicable fees, charges and taxes.
I further authorize the Bank to deduct from my Loan proceeds all fees including, but not limited to, processing fees, documentary
Yes ✔ No stamp tax, notarial fees and interest accruals should the first due date be over 30 days from the release of my loan and other related
charges.
I likewise authorize the Bank to provide me with a consumer loan or additional bank product/s (such as but not limited to auto,
Educational Attainment: housing, credit card and other products suited to my situation) at the Bank’s sole discretion. My acceptance of the credit card or the
proceeds of any loan released pursuant thereto shall be conclusive proof of my acknowledgement of my additional obligations and/or
High School Vocational ✔ College Post Graduate Others:____________ indebtedness to the Bank under the Terms and Conditions set forth by the Bank and prevailing at the time the credit card is issued or
the additional loan is approved.
Business / Employer: Position: I hereby agree that the Bank has the right to approve a lower amount than my desired loan amount as indicated in this
application and shall render the Bank free and harmless from any liability arising thereof.
I hereby agree that should my application be denied, the Bank has no obligation to furnish the reason for such rejection or to
Moonleaf Tea Shop Owner / General Manager return my application and other submitted documents.
I also legally bind myself to the Terms and Conditions of the Loan Program Promissory Note, Disclosure Statement and other
Business / Employer Address (Floor, Street, Brgy./Village, Subdivision, City/Municipality, Province): Zip Code: relevant documents that I shall execute in favor of the Bank.

2/F Klircon Bldg. 192 Maginhawa St. Sikatuna Village, Quezon City 1101
Office Phone No.: Number of Dependents:
Children: 3 Others: (Relationship___________) Borrower's Signature Above Printed Name Date

MY WORK AND FINANCES

Employment Type: Permanent: FOR BANK’S USE ONLY
Government ✔ Private ✔ Self-Employed Yes No
Rank: Rank and File
Assistant Manager / Senior Assistant Manager Junior Officer
Assistant Vice President / Senior Assistant Vice President Manager / Senior Manager
Vice President / First Vice President / Senior Vice President / Executive Vice President Channel Source Source Code

President / Chief Executive Officer / Director / Chairman

Referror / Account Officer / DSA
Position:
Owner / General Manager

ARE YOU QUALIFIED? REQUIREMENTS

• At least 21 years old but not more than 65 years old upon loan maturity
Duly filled- out and signed Loan Application Form
• Filipino citizen
• With office or residence landline Employed
• Residence or office is within Bank’s service processing area • Photocopy of company ID with clear photo and signature
• Photocopy of one (1) valid government-issued photo ID with three (3) specimen signatures
Employed • Latest one (1) month payslip
• Regular and permanent with current employer and with total
• Latest BIR Form 2316 or latest COE or latest three (3) months payslip (in lieu of the ITR)
employment of at least one (1) year
• Minimum gross monthly income:
Self-Employed
For Metro Manila: Php 15,000
• Two (2) valid government-issued IDs
For outside Metro Manila: Php 12,000
• Latest ITR with BIR stamp
Self-Employed • Latest two (2) years Audited Financial Statements
• With at least two (2) continuous years of profitable • SEC Registration / DTI Certificate
operations in the same line of business • Business Permit/Mayor’s Permit
• Minimum gross monthly income: • Latest six (6) months bank statements
For Metro Manila: Php 30,000 • List of 3 suppliers and 3 customers with contact details
For outside Metro Manila: Php 25,000 • Latest General Information Sheet (If corporation)