NEW ACCOUNT APPLICATION

(I .D. PICTURE)
7 th Floor, The Richwell Center
102 Timog Ave., Quezon City
Philippines
TRUNKLINE: (632) 375.15.60 TO 63
TELEFAX: (632) 376.22.93

Fill in the blanks properly. Blanks that could not be filled-up in relation to requirement should be marked “NOT APPLICABLE”

1 PERSONAL INFORMATION
Name: (Last, First, Middle)

Bartolazo, Ronan Byron Babilonia

Residence Address: Telephone / Mobile No.:

872 F. Gomez st. Brgy. Malusak, Santa Rosa, Laguna 09498604311

Business Address: Telephone / Mobile No.:

107 Purok 2 F. Gomez st. Brgy. Aplaya, Sta. Rosa, Lag.

Birth Date: Birth Place: Status:

June 15, 2000 Santa Rosa, Laguna Single

Name of Spouse: Birth Date:

2 BUSINESS INFORMATION
Customer type:
Dealer End-User Feeder-Dealer

Business Affiliation/ Associate/ Companies or Employment:

Name of Company: Address: Phone Numbers Position/Affiliation:

Main Source of Income Annual Gross Income Annual Net Income

Other Source of Income Annual Gross Income Annual Net Income

Farm Data (if applicable):

Total Land Area of Livestock Animal Population (Capacity): Actual Animal Population: Species Raised (Swine, Broiler,
Farm: Etc.):
100 swine, 100 Rhode Island Red 70 Swine , 100 Rhode Island Red Swine, Chicken, Goat
1000 sq. m
Estimated Monthly Feed Consumption: Feed Brand Used: Annual Yield (Tons/# of
Animals):
45,000 BMeg
Monthly Sales Volume (if Feed Dealer):
Feed Brand: Sales Volume: Discounts: Transaction (Cash or Term):

Feed Brand: Sales Volume: Discounts: Transaction (Cash 0r Term):

3 FINANCIAL STANDING

Details of monthly Installment/Debts (including all existing loans and finances)

 Creditor Address Security Date Maturity Original Outstanding Monthly
Granted Date Amount Balance Amortization

Assets and Liabilities:

A. ASSETS B: LIABILITIES

Particulars Amount Particulars Amount

Cash on hand Ps Revolving Charge Ps

Account

Trade Receivables Unsecured Loan

Merchandise Inventory Real Estate Mortgage

Loan

Automobile Automobile Lone

Real State and Stocks Appliance Loan

Other Assets Other Debts (Pls specify)

TOTAL ASSETS Ps TOTAL LIABILITIES Ps

NET WORTH ( A-B): Ps

Bank Accounts:

Bank Branch Type of Account No. Balance

Account

Properties Owned:
Location /TCT No./ Type of Property Acquisition Market Value Mortgage
Registration No. Cost Balance
 Collateral (In case the Company will require you a security / collateral, what can you offer to us?):
Real estate Other Collaterals to Offer:
TCT No. Lot Size:

Type of property: Estimated Market Value:

REFERENCES
4
Loan and Credit References:
BankFinancial Highest Outstading Date Date Fully
Institution Purpose Security Amount Balance Obtaained Paid
Loaned

Trade References:
Name of Supplier Address Tel. No. Monthly Transaction
Amount (Pesos)

Name of Customer Address Tel. No. Monthly Transaction

Amount (Pesos)

I/We affirm that each of the statements made in this application is true and correct
and agree to notify ProNatural Feed Corp. / Santeh Feeds Corp. of any material
change affecting the information contained herein. I/We authorize you to obtain and
verify such information as may be required covering the application for the above
references or any other sources. I/We agree that all information obtained by
ProNatural Feed Corp. shall remain its property whether or not the credit is granted.

X
Printed Name:
Signature of Applicant/s:
Ronan Byron B. Bartolazo
 Signature of Spouse: Printed Name:

X
Place of Signing: Date of signing (day/month/year)

5 ATTACHMENTS

Please attach the following documents:

Properly Filled-up Bank Verification Form Department of Trade and Industry Registration
Mayor’s Permit of Current Year Financial Statement of the Last Two Years
Business Permit of Current Year Income Tax Return of the Last Two Years
Sanitary Permit Photocopy of Marriage Contract