CHANNEL PRODUCT

___ Branch Repo ___ Big Bikes

APPLICATION FORM ___ Dealer Sales

___ Employee
___ Repo Warehouse
___ Regular
___ Repo
___ TC Package
___ Website

Date Time Dealer Branch Motorcycle Unit Applied

Suggested Retail Price (SRP) Down Payment Amount Financed Term Monthly Amortization

Existing Motorcycle Sales and Service Associate / Dealer Representative Referred by / Agents Name
Cash ____ Financing ____ NA ____
Purpose of the Motorcycle Loan

Beneficial Owner / User ____________________________ Personal____ Business _____ Details of Usage:______________________________________________________________________

APPLICANT (Individual / Sole Proprietorship)
Last Name First Name Middle Name Birthdate (MM/DD/YYYY) Place of Birth

Residence Address (Please put a check mark on your preferred mailing address.) Email/Facebook Gender
Present Address Permanent Address
Nationality Marital Status
Condo Unit/Apartment No.
Residence Ownership
House-Block-Lot No./Phase

Street/Village ____ Owned ____ Rented ____ Stay-in

____ Mortgaged____ Transient ____ Living w/
Barangay parents / relatives
Cellular Phone No. Telephone No.
Municipality/Province

Length of Stay Year(s) Month(s) Year(s) Month(s) TIN SSS GSIS No. __________________
SPOUSE INFORMATION
Last Name First Name Middle Name Birthdate (MM/DD/YYYY) Place of Birth

Residence Address (Please put a check mark on your preferred mailing address.) Email/Facebook Gender
Present Address Permanent Address
Nationality Marital Status
Condo Unit/Apartment No.
Residence Ownership
House-Block-Lot No./Phase

Street/Village ____ Owned ____ Rented ____ Stay-in

____ Mortgaged____ Transient ____ Living w/
Barangay parents / relatives
Cellular Phone No. Telephone No.
Municipality/Province

Length of Stay Year(s) Month(s) Year(s) Month(s) TIN SSS GSIS No. __________________
CO-MAKER INFORMATION
Last Name First Name Middle Name Birthdate (MM/DD/YYYY) Place of Birth

Residence Address (Please put a check mark on your preferred mailing address.) Email/Facebook Gender
Present Address Permanent Address
Nationality Marital Status
Condo Unit/Apartment No.
Residence Ownership
House-Block-Lot No./Phase

Street/Village ____ Owned ____ Rented ____ Stay-in

____ Mortgaged____ Transient ____ Living w/
Barangay parents / relatives
Cellular Phone No. Telephone No.
Municipality/Province

Length of Stay Year(s) Month(s) Year(s) Month(s) TIN SSS GSIS No. __________________
SOURCE OF INCOME
PRINCIPAL APPLICANT
Company Name / Business Name Nature of Business Contact Number

Company Address / Business Address Length of Stay Position Title

Condo Unit/Bldg No./Name

Gross Monthly Income
House-Block-Lot No./Phase
Employment Status:
Street/Village ____ Employed

Barangay ____ Self-Employed ____ Regular

____ Contractual
Municipality/Province ____ Others___________ ____ Probationary
Other Sources of Income Gross Income

SPOUSE CO-MAKER
Company Name / Business Name Nature of Business Contact Number

Company Address / Business Address Length of Stay Position Title

Condo Unit/Bldg No./Name

Gross Monthly Income
House-Block-Lot No./Phase
Employment Status:
Street/Village ____ Employed

Barangay ____ Self-Employed ____ Regular

____ Contractual
Municipality/Province ____ Others___________ ____ Probationary
Other Sources of Income Gross Income
 CHARACTER REFERENCES
FULL NAME CONTACT INFORMATION RELATIONSHIP

3
SUMISHO REMARKS

SKETCH
Guide: (1) Please provide the best way to locate Applicant's residence (fastest and safest); (2) Please provide specific landmarks; (3) Please include nickname of Applicant (known name in the area).

UNDERTAKING

I/We hereby authorize Sumisho Motor Finance Corporation or any of its authorized representatives to enter, inspect and take photos of my/our premises as part of its credit verification procedures.

I/We hereby certify that the information in this application form and all supporting documents, are true and correct. I/We hereby authorize Sumisho Motor Finance Corporation (Sumisho) to verify all
such information about me/us, including previous credit transaction(s) with other institutions. Relative to this, I/We expressly waive any and all statutory provisions governing confidentiality of such
information if applicable. I/We fully understand that any misrepresentation or failure to disclose information on my/our part as required herein may cause the disapproval of my/our application.

I/We hereby agree and consent that Sumisho may collect, use, disclose, process, retain or dispose my/our personal information contained in this form and/or otherwise provided by me/us or obtained
by Sumisho in the course of its verification process in compliance with Data Privacy Act (R.A. No. 10173) and its Implementing Rules and Regulations (IRR).

I/We hereby acknowledge and consent that my/our personal data may be disclosed by Sumisho to its third party service providers. Said third party service providers, if engaged by Sumisho, may only use
my/our personal data for and in behalf of Sumisho.

I/We hereby agree that the application form remains as Sumisho property and the same may be used for my loan application and any other marketing and promotional activities of Sumisho, its affiliates,
business partners and related companies. I/We agree that my/our personal information shall be retained by Sumisho in accordance with existing laws and regulations on Anti-Money Laundering Act
(AMLA), without prejudice to my/our rights as data subject(s) under the Data Privacy Act.

I/We hereby agree to comply with the loan application and requirements subject to Bangko Sentral ng Pilipinas (BSP) and Securities and Exchange Commission (SEC) circulars, rules and regulations; and
policies of Sumisho.

Upon the acceptance of my/our loan application, I/We hereby legally and validly bind myself/ourselves to the terms and conditions of Promissory Note with Chattel Mortgage, but not limited to joint and
several liabilities for all charges, fees and other obligation(s) necessary in processing my/our loan application.

I/We hereby authorize Sumisho to conduct verification with the Bureau of Internal Revenue (BIR), my/our banks/financial institutions, my/our business or employer the authenticity of the submitted
requirements. I/We submit and hereby waive the confidentiality of any personal information obtained in the course of the verification. I/We waive my/our rights under the Bank Secrecy Law (R.A. 1405).

I/We hereby agree that the data/figures in my financial documents shall be considered in evaluating my/our financial capacity and credit worthiness of my/our application.

Should any document(s) submitted prove to be spurious or incorrect in material detail, Sumisho may terminate any loan or other credit accommodation granted on the basis of said document(s) and
shall have the right to demand immediate payment or liquidation of the obligation. Moreover, in case of disapproval of my/our application, I/We hereby understand that Sumisho is not obliged to
disclose the reason(s) for such disapproval.

I/We hereby authorize Sumisho to send me/us updates about my/our loans via SMS/text, e-mail, mail or other means of communication.

I/We hereby voluntarily agree that Sumisho has sole option to debit my/our accounts at any Sumisho affiliated bank to cover the payment in full of any loan obligation due and/or other amount due
including but not limited to penalty charges, insurance, interest and other applicable fees provided for in this agreement and other documents executed that are relevant and connected therewith.

I/We hereby authorize Sumisho to include my/our name(s) and other pertinent information about my/our loan history in any credit bureau or institution as may be required by law.

I/We hereby acknowledge and authorize: (1) the regular submission and disclosure of my/our basic credit data to the Credit Information Corporation (CIC) as well as any updates or corrections thereof, as
defined under the Credit Information System Act (R.A. No. 9510 and its IRR); (2) the sharing of my/our basic credit data with other lenders authorized by the CIC and credit reporting agencies duly
accredited by the CIC.

I/We hereby waive my/our rights under the provisions of the Rule of Writ of Habeas Data (A.M. No- 08-1-16-SC) issued by the Supreme Court. It is further understood that Sumisho may decline or evoke
the loan application in its absolute discretion.

Full Name and Signature of Principal Applicant Full Name and Signature of Spouse / Co-Maker
SMD-03-19-002 v2