Kffi

Attorney-ln-FacULoanAdministrator's
lnformationSheet
Name:
LastName FirstName MiddleName
Address:
Residence:
Present
:
Address
Permanent
Business/ Office:
EmailAddress :
Natureof WorUBusiness :
Nameof EmployerlBusiness :
Sourceof Funds: No.
TIN/SSSNo./GSIS
ContactNumbers:
Residenc6: Office: Cellphone: Fax No.:
Personallnformation:
Date of Birth : Placeof Birth: Age:
Status i : Sex/Gender : Citizenship:

Relationshipto Borrower/Co'borrower/Grantor:
Spouse(if any):
LastName FirstName MiddleName
:
Dateof Birth: I Placeof Birth: Age: CitizenshiP:
Reasonfor appointmentof Attorney-in-FacULoan Administrator:

SpecimenSignatures:
1.
'2.
3.

lArVehereby certify that the information contained herein is/are true and correct and that lM/e have been appointed as
attorney-in-fact/loanadministratorof the following:

:
Borrower I

Co-Borrower

authorizeBanco De Oro Unibank,lnc. (BDO)to discloseto any entityany/allinformation

We furtherinevcrcably
providedhereinas maybe requiredby relevantlawsor regulations.

overprintedname
Signatureof AIF/LoanAdministrator

Affirmedby:

overprintedname
Signatureof Borrower/s