PEAK Motor Philippines

Mitsubishi Motors Authorized Dealer

MOTORS

Auto Loan Application for Individual and Single Proprietorship

Last Name

First Name

APPLICANT
Middle Name

Applicant: ________________________________________________________Age: _____ Birthday: ___/___/___

Spouse:

________________________________________________________Age: ______ Birthday :___/___/___

Address: ___________________________________________________________Status: Single [ ] Married [ ]

E-mail :

______________________Mobile No.:____________________________ Separated [ ] Widowed [ ]

Length of Stay:__________________Tel. No.:_______________________________

Ownership: Owned [ ] Mortgage [ ]

Citizenship:__________ No. Of Dependents:____________

Rented [ ] Used Free [ ]

Previous Address:___________________________________________________Length of Stay:________________
Provincial Address:__________________________________________________Length of Stay:________________
APPLICANT

Employment [ ]

YOUR INCOME COMES FROM

Business [ ]
SPOUSE
Employment [ ]

Business [ ]

Emp/Bus. Name:_______________________________Emp/Bus. Name:___________________________________

Address:______________________________________Address:_________________________________________
Position:______________________________________Position:_________________________________________
Tel. No.:________________Length of Stay:_________ Tel. No.:_________________Length of Stay:_____________
Previous Employer:______________________________ Previous Employer:________________________________
Address:______________________________________ Address:_________________________________________
COLLATERAL / SECURITY
Unit/Model:___________________User: MITSUBISHI____________
Dealer: PEAK MANILA BAY____Salesman: JOCELYN C. CALUD_
LCP: _______________ DP: ____________(%) Term: ___________
Loan Value: _________________ Place of Use:________________
Purpose: Private [/ ]
Business [ ]
Public [ ]
FOR BANK USE ONLY

MONTHLY INCOME / EXPENSES

Borrower
P
Spouse
Other Income
SUB-TOTAL
LESS:
Living Expenses
Rental
Amortizations

Area:____________Dealer:______________Trans. Type_________
Source__________Branch:______________Ref. Agent__________

____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________

TOTAL

Prod. Code______Prod Kind____________Salesman____________

_____________________

Have you had previous accounts with us?

No [ ]
Yes [ ] Account Number__________________________________
REFERENCES
Name
Address
Tel. No.:
Personal ______________________________________________________________________________________
Trade
______________________________________________________________________________________
Supplier ______________________________________________________________________________________
Bank _______________________________Branch _________________________Type of Account______________
Bank_______________________________Branch __________________________Type of Account _____________
TIN No.: ____________________________
I/We affirm that the statement made in this application and the information given by me/us are true and correct.

________________________ ___________________ _____________________________ ___________________

Signature of Borrower

Date Signed

Signature of Spouse/Co-Maker

Date Signed