APPLICATION FORM: Unit: Downpayment:15% Term:5 years

PRINCIPAL BORROWER
First name: Josephine
Middle name: Floreta
Last name: Montefalcon
Mother's maiden name: Musico
Civil status: Maried
Birthday: Feb. 15, 1984
Citizenship: Filipino
Complete address: P6. Brgy. Poblacion, Las Nieves Agusan del Norte
Years stayed: 35
Landline:
Cellphone no.: 09297637888
Company/business name: DepEd
Company/business address:
Telephone no.:
Years with the company:
Position: Monthly income:
Main bank and branch: SSS/GSIS No.:
TIN No.:
CO-BORROWER Relationship with the principal: Husband
borrower: First name: Leonides
Middle name: Jumalon
Last name: Montefalcon
Mother's maiden name: Jumalon
Civil status: Maried
Birthday: Jan. 28, 1983
Citizenship: Filipino
Complete address: P6. Brgy. Poblacion, Las Nieves, Agusan del Norte
Landline: Cellphone no.: 09120827861
Company/business name: LJYM Tshirt Printing and Computer Services
Company/business address: P6. Brgy. Pob. Las Nieves, Agusan del Norte
Telphone no.:
Years with the company: 3
Position: Owner
Monthly income: 30,000.00
Main bank and branch: Metrobank, Butuan City
SSS/GSIS No.:
TIN No.: 710-843-125-000