LOAN APPLICATION FORM

RISE UP Micro and SME Tindahan Loan Program

AFFILIATION TO FMCG
FMCG Manufacturer: ________________________
COCA-COLA FMCG Account Code: ____________________________
505334540

BORROWER’S INFORMATION
Last Name: BARBA First Name: RANDOLPH Middle Name: LUMANGYAO

Suffix: Date of Birth: 10/21/1980 Sex: Male Female

Mobile No.: (0935) 1911021 Landline No. E-mail Address: randolphbarba@gmail.com

RESIDENTIAL ADDRESS
0168 PUROK DARUHAN CENTRAL (POB.)
House/Lot No., Street Name, Subdivision Barangay
TARRAGONA DAVAO ORIENTAL Region XI (DAVAO REGION)
City/Municipality Province Region

BUSINESS INFORMATION
Business Name: MB COMPUTER SOLUTIONS

Business Address: Same as residential address of the borrower Not same as residential address of the borrower
(Supply this only if different from residential address provided above)

0168 PUROK DARUHAN CENTRAL (POB.)

House/Lot No., Street Name, Subdivision Barangay
TARRAGONA DAVAO ORIENTAL Region XI (DAVAO REGION)
City/Municipality Province Region

Estimated Asset Size: 3000000

(Excluding land)
REQUESTED LOAN TERMS
Loan Amount: PhP 4,714,123 Loan Tenor: 36

Grace Period: 6 Service Fee: 3.00%

LOAN RELEASE DETAILS

PHILIPPINE NATIONAL BANK RANDOLPH BARBA 401010100627
Bank/EMI Name Account Name Account No.
CHECKLIST OF REQUIREMENTS
A selfie of the loan applicant holding a valid ID clearly capturing One (1) valid ID of the loan applicant
both the loan applicant’s face and valid ID

For corporations: Latest General Information Sheet For partnerships: Articles of Partnership

For corporations: Secretary’s Certificate/ Board Resolution For partnerships: Partnership Resolution
One (1) minute video showing the financial condition and assets Three (3) photos showing the following: 1) business signage; 2)
of the business. inventories; and 3) fixed assets

For loans up to PhP100.0 thousand: current or previous year’s Barangay Permit; or

For loans above PhP100.0 thousand: current or previous year’s Mayor’s Permit or Barangay Micro Business Enterprise Certificate

Proof of bank account or e-money account

UNDERTAKING/ DECLARATION
I/We hereby confirm that all information and supporting documents provided herein are true, accurate and complete and I/we
agree to notify the Small Business Corporation (SBCorp) of any changes in any of the information supplied. I/We further
authorize SBCorp to verify and validate all information and supporting documents that I/We submitted to SBCorp before all the
concerned government agencies (DTI, BIR, SEC, and LGUs). In the event that, SBCorp upon verification with the concerned
government agencies discovers that any and/or all information or supporting documents submitted is/are
inaccurate/false/fraudulent, I/We acknowledge that SBCorp can withdraw or cancel any loan approval issued in my/our favor.

I/We authorize SBCorp to obtain relevant information as it may require concerning this application. I/We hereby agree that this
application shall be subject to applicable laws (BSP circulars, rules and regulations) and policies of SBCorp.
DATA PRIVACY CONSENT
In compliance with the requirements of the Data Privacy Act (DPA), I/we hereby authorize and give my/our consent to Small
Business Corporation (SBCorp) on the general use and sharing of information obtained in the course of my/our transaction. Any
disclosed information, including personal and sensitive information may be collected, processed, stored, updated, or disclosed
by SBCorp on the following purpose:
a. For legitimate purposes and requests;
b. To implement transactions which the borrower requests, allows, or authorizes; and;
c. To provide new and related products and services of SBCorp; and
d. To comply with the SBCorp’s internal policies and its reporting obligations to the government authorities under
applicable laws.
I/ we certify that all provided information is correct and true to my /our knowledge. Any false information and
misrepresentation made in this document shall cause the filing of administrative/criminal case/s against me/us. I/We authorize
SBCorp to verify/validate the information and supporting documents I/We submitted to SBCorp before the concerned
government agencies (DTI, BIR, SEC, and LGUs). Moreover, I/we confirm and recognize that SBCorp or their credit delivery
partners and service providers may disclose collected information or any basic credit data including related changes or
correction on the data in Credit Information Corporation (CIC) and other authorized entities as stated in the Credit Information
Act of 2002 (R.A. 9510).

RANDOLPH LUMANGYAO BARBA 11/25/2022

Signature under Printed Name (Borrower) Date

Signature under Printed Name (Co-borrower) Date