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PERSONAL LOAN APPLICATION FORM

(INDIVIDUAL)

DSA:
Agent:

Code:
Code:

Branch:
Others:

Code:
RM/AO:
Promo/Program Code:

Code:

Note: Please print legibly. If field not applicable, please write N.A. Processing of application will start only upon submission of all required documents.

LOAN INFORMATION
Desired Loan Amount: P
Loan Purpose:
Home Improvement

Travel/Vacation

Tuition Fee/School Expenses

Car Repair

Medical/Hospital

Credit Card Payment

Appliance/Furniture Purchase

Wedding/Special Events

Business Related

Others:

PERSONAL INFORMATION
Last Name
Applicant:
Status:

First Name

Middle Name
Gender:

Married

Single

Separated
Widowed
Birthdate(mm/dd/yyyy): __/__/____

Citizenship:

Male
No. of Dependents:
Birthplace:
Length of Stay:
Length of Stay:
Length of Stay:

Age:

Present Home Address:


Previous Home Address:
Permanent Home Address:
Mailing Address:
Tel. No.:
TIN:

Mobile No.:

Email:

SSS No.:

GSIS No.:

Present Home Ownership:

Owned

Rented

Estimated Value:

Mortgaged Estimated Value:


Educational Attainment:

College
Highschool
Type of Car/s Owned:

No. of Cars Owned:

Living with Relatives


Bank:

Balance:
Post Graduate

Vocational
Make and Year:

Do you have any relatives working at PBCOM?


Exisiting PBCOM Client?

Yes

Yes
No If Yes, Name:
If Yes, type of account:

No

Female

Relationship:
Account No.:

SPOUSE / CO-MAKER PERSONAL INFORMATION


Last Name

Spouse/
Co-Maker:

First Name

Middle Name
Male

Gender:

Female

If Co-Maker, relationship to borrower:


Status:

Single

Separated

Married

Widowed

Citizenship:
Birthdate(mm/dd/yyyy): __/__/____
Present Home Address:
Previous Home Address:
Permanent Home Address:
Tel. No.:
Email:
Mobile No.:
TIN:
GSIS No.:
SSS No.:
Exisiting PBCOM Client?
Yes
No
If Yes, type of account:

No. of Dependents:
Age:

Birthplace:
Length of Stay:
Length of Stay:
Length of Stay:

Account No.:

SOURCE OF FUNDS
Applicant
Employed
Private

Self Employed
Retired

Government
Employer/Business Name:
Address:
Occupation:

Unemployed

Position:

Nature of Work/Business:
Tel. No.:
Tenure:
Previous Employer:
Total No. of Years Working:
Gross Monthly Income:
Monthly Living Expense:
Other Income Source:
Investments
Family Business

Pension
Other

Spouse/Co-Maker
Employed
Private

Self Employed
Retired

Government
Employer/Business Name:
Address:
Occupation:

Unemployed

Position:

Nature of Work/Business:
Tel. No.:
Tenure:
Previous Employer:
Total No. of Years Working:
Gross Monthly Income:
Monthly Living Expense:
Other Income Source:
Investments
Family Business

Pension
Other

REFERENCES

Name

Address

Tel. No.

Personal
Trade
Supplier

Credit Cards

Credit Card Company

Bank Accounts

Loans

CREDIT CARDS / BANKS / FINANCING INSTITUTIONS


Card Number

Credit Limit

Outstanding Balance

Member Since

Bank/Branch

Account Type

Account Number

Current Balance

Creditor

Loan Type

Current Balance

Monthly Amortization

DECLARATION
I/We warrant that all information provided in this application form are true and correct. I/We agree that any material misrepresentation
or falsity can be used by Philippine Bank of Communications (PBCOM) to pursue civil and/or criminal liabilities against me/us.
I/We understand that PBCOM may, at its sole discretion, deny this application and further agree that PBCOM has no obligation to notify
and furnish me/us the reason for such denial. Furthermore, I/we agree that all information obtained by PBCOM shall remain its property whether
or not the application is granted.
source, any credit reporting agency or any third party, for purpose of, among others, evaluating this application form, for credit reporting,
and harmless from any liability that may arise from obtaining or disclosing such information.

stamp taxes, processing fees and such other fees as may be charged by PBCOM in connection with the loan shall be for my/our account.

Signature of Borrower over Printed Name


Date:

Signature of Spouse/Co-Maker over Printed Name


Date:

DISCLOSURE OF INTEREST RATES, FEES & CHARGES

* Interest rates and charges are subject to change without prior notice. All applications will be subject to the Banks credit policies and procedures.

INSURANCE (OPTIONAL)
I would like more information on the Credit Life Insurance Product once my loan application has been approved. The Credit Life
Insurance will cover the unpaid balance of the loan in the event of my untimely death.
I further understand that the Credit Life Insurance Product is optional and has no bearing on the granting of the loan.

Signature of Borrower over Printed Name


Date: