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LOAN APPLICATION FORM

PERSONAL INFORMATION

Name (last Name, Given Name, Middle Name) Amount Applied Agent Name
TAQUIO, FRANCISCO, BABSA-AY 1,000,000.00

Gender Birth-Date Civil Status Nationality #dependent Email

M F 10 06 1971 MARRIED Filipino 3 nhammatiinc@gmail.com
X

TIN 763-306-4725-000 SSS/GSIS Philhealth/Pagibig Com Tax Cert

Present Address Educational Attainment/Degree

Rm 8 PCCI-BBC Building, PTA Complex, Gov. Pack Road, Session Road Area
Baguio City College Graduate -BSCE

Tel No. 074 309 4864 Mobile No. 09397708565 ZIP Code 2600 Length of Stay in
Present Address 3 years 2 mos
Provincial Address Home Ownership
ADAFANG, POBLACION, TUBA, BENGUET Mortgaged x Owned
Living w/ Relatives Rented
Tel No. Mobile No. 09951452139 ZIP Code 2603

Name of Spouse Birthdate 08 30 1975

FLORNARIZA L. TAQUIO

CO-MAKER INFORMATION

Co Maker Name Birthdate Email TIN/SSS

FLORNARIZA L. TAQUIO AUGUST 30, 1975 ftaquio2016@gmail.com

Home Address Contact No.

ADAFANG, POBLACION, TUBA, BENGUET 09186203967

Business Name/Nature Business Address

FTAQUIO BOOKKEEPING SERVICES 8 PCCI-BBC BLDG., PTA COMPLEX GOV PACK ROAD, BAGUIO CITY

BUSINESS INFORMATION

Business Name Tel/Fax No 074 3094864

NHAMMATI INC
Business Address RM 8 PCCI-BBC, PTA COMPLEX, SESSION ROAD AREA, BAGUIO CITY Email Address nhammatinc@gmail.con

Nature of Business No. of Employees Date registered/Years in Operation

Mushroom farming, Grocery - retail and wholesale 8 3 years

BANK’S INFORMATION

Bank Name/Branch Account Number Date Opened Balance

East West Bank, Legarda 200042208204 February 2020 500,000.00

 SUPPLIERS INFORMATION
Name Address Contact No.
Molla Mushroom Farm Pico, La Trinidad, Benguet 09085556343
Tony Beth Mushroom Farming Pugo, La Union 09099554621

CLIENTS INFORMATION
Name Address Contact No.
Taloy Farmers Multi Purpose Cooperative Taloy Norte, Tuba, Benguet 091294107065
Coach Corner Restaurant Kisad Road, Baguio City 09154898405
Norilyn Tangalin Gov. Pack Road, Baguio City 09465864415

FRIENDS AND RELATIVES INFORMATION

Name Address Contact No . Relationship
Mrs. Trinidad Trinidad Marcos Highway, Baguio City 09998784615 Friend
Charlie B. Taquio Malabon, Metro Manila 09959288280 Brother
Oliver Taquio BGH, Pico, La Trinidad, Benguet 09219990689 Cousin

We hereby certify that the above information are true and correct. In this connection, we hereby authorize JNRI
Credit 127 Corporation to perform a credit investigation on our credit background based on, but not limited to, the
information stated in this application form.

For Nhammati Inc: Francisco B. Taquio

Borrower Co-Borrower
(Signature over Printed Name) (Signature over Printed Name)

With Marital Consent:

Spouse of Borrower
(Signature over Printed Name)

To be filled-up by Lending Agent

This applicant/borrower and his co-maker are both known to me as good credit risk. I hereby recommend
approval of their loan application

Lending Agent:

____________________________________
(Signature over Printed Name)

Verified by: _______________________

Endorsed by: ______________________

Approved by: ______________________