HOME LOAN

BROKER’S ACCREDITATION
Recent 1” x 1” photo
APPLICATION FORM

PERSONAL INFORMATION
Name (Last Name, First Name, Middle Name) Gender Birthdate (mm/dd/yyyy) Age Place of birth

SABINO, HERSHEY RAMOS Male ■ Female

Citizenship Marital status SSS/GSIS no.
Filipino Single Widowed ________ mos./yrs.
Others (please indicate) ■ Married _______ mos./yrs. Separated _______ mos./yrs.

PRESENT RESIDENCE ADDRESS

Address (No./Street/Barangay or Municipality/City/Province) ZIP code

PHASE 4C BLOCK 4 LOT 20 CHAMPACA STREET GREENLAND SUBD. BRGY SAN JUAN CAINTA RIZAL
Length of stay in present address Home ownership Residence telephone no. Mobile phone no.
_______ Years _______ Months Rented ■ Owned Living with relatives Others (please indicate) ___________

PREVIOUS RESIDENCE ADDRESS (if present address is less than 2 years)

Address (No./Street/Barangay or Municipality/City/Province) ZIP code Previous residence telephone no.

Length of stay in previous address Home ownership Contact person/relationship

_______ Years _______ Months Rented Owned Living with relatives Others (please indicate) __________________

PERMANENT ADDRESS
Address (No./Street/Barangay or Municipality/City/Province) ZIP code Residence telephone no.

Length of stay in permanent address Home ownership Contact person/relationship

_______ Years _______ Months Rented Owned Living with relatives Others (please indicate) __________________

EMPLOYMENT INFORMATION
Present employer/business name Position/Rank/Department assigned Length of stay with the company/business Monthly income

_______ Years _______ Months

(No./Street/Barangay or Municipality/City/Province)

Monthly income from other source(s)/indicate source(s)

PREVIOUS EMPLOYMENT/BUSINESS RECORD

Company/Business name Position/Rank/Department assigned Years/Months stayed

SPOUSE INFORMATION
Name (Last Name, First Name, Middle Name) Birthdate (mm/dd/yyyy) Age Citizenship
Filipino Others (please indicate) _____________

Mobile phone no. SSS/GSIS no.

Present employer/business name Position/Rank/Department assigned Length of stay with the company/business Monthly income

_______ Years _______ Months

(No./Street/Barangay or Municipality/City/Province)

REAL ESTATE RECORD

How long have you been in Real Estate Business? Property value
type of property?
_______ Years _______ Months PHP500,000 and below
Vacant lot ■ Townhouse Above PHP500,000 - PHP2 Million
Are you a licensed real estate broker?
■ House and lot Others (please indicate)
Above PHP2 Million - PHP5 Million
■ No
Yes, License no. ______________ Date issued _______________
■ Condominium ■ Above PHP5 Million
Broker company name _________________________________ Where is your area of concentration?

License no. ____________________________________________ ■ Metro Manila North Luzon South Luzon Others (please indicate)

SHARE WITH US YOUR SALES RECORD?

Project name Developer No. of units sold

FINANCING INSTITUTION(S) ACCREDITED WITH Inclusive dates

OTHER INFORMATION
Own a house? Own a car? Number of children/dependents
No Yes (please indicate property value/price) No Yes (please indicate make/year/model)

PRESENT MEMBERSHIP (Name of Socio-Civic Groups, NGOs etc)

Organization Position Year

CHARACTER REFERENCE/S
Name Address Contact number(s) Relationship

IDENTIFICATION
At least two (2) valid IDs, PHOTOCOPY, and ORIGINAL must be presented (at least one (1) should be government-issued)

ID number Place of issuance Date of issuance Valid until

I do hereby certify that the information provided herein in connection with my application for accreditation as a retained service provider for Security Bank is accurate and complete in all
respects. I understand and accept that any inaccuracy or false statement contained herein shall constitute grounds for immediate termination by Security Bank of any relationship, which
may currently or in the future exist between the Bank and myself. I understand and agree that my application for accreditation is subject to an approval procedure within Security Bank
and the application may be rejected with or without cause, and without statement of a reason. In connection with the review of my application, there may be an investigation and verification
of the information contained in the application. I agree to execute such releases and/or other documents as may be required for such investigation.

FOR BANK’S USE ONLY

Endorsed and authenticated by Applicant BI/CI conducted by Applicant status

Approved Disapproved

Signature over Printed Name Signature over Printed Name

of Bank Employee of Bank Employee

Credit cycle head/date

Date endorsed and authenticated Date conducted

Remarks

HOME LOAN BROKER’S UNDERTAKING

I, ________________________________________________, do hereby state and undertake to abide by the following Terms and Conditions:
1. I acknowledge that accreditation is at the sole discretion of Security Bank, hereinafter referred to as “Bank.” I hereby authorize the Bank to process my personal data
provided in this form for the purpose of accreditation and to conduct background and credit checking to verify the information I declared with any individual, corporate entity
or government agency. I agree that I have no cause of action against the Bank for the grant or denial of my application for accreditation.
2. I am not an employee, agent, partner of the Bank nor in joint venture agreement with the Bank with regard to my function as a Home Loan Broker. Likewise, any person
that I may hire or contract shall not be considered as employee, agent or sales representative of the Bank. The Bank shall deal directly with me alone with regard to my
function as a Home Loan Broker.
3. As a Home Loan Broker, my duty is limited to making referrals to the Bank and I undertake not to solicit or market loans of the Bank.
4. I shall receive my commission via credit to my designated Security Bank Checking, Savings, or Cash Card Account Number, which account must be under my name only
(not a joint account).
5. I shall ensure that all signages, IDs, calling cards, stationeries and other similar materials to be used in relation to my function as a Home Loan Broker do not include the
Bank’s logos and corporate brand prints. I understand that the Bank is not obliged to provide me any of the foregoing materials.
6. I undertake to inform my prospects to completely fill out the Bank’s Home Loan Application Form and to disclose accurate information and submit photocopies of documents
which are true reproductions of the originals.
7. I undertake to cooperate with the Bank’s Account/Sales Officer in following up from my prospects all the requirements of the Bank necessary for the processing of my
prospects’ application. I declare that I am duly authorized by my prospects to submit the requirements to the Bank.
8. I shall safeguard, according to the strict standards of security and confidentiality, all information my prospects share or will be sharing with me. I declare that I am duly
authorized to share the information to the Bank and that I am not in breach of any obligation to my prospects.
9. I understand that approval or disapproval of my prospect’s application is subject to the sole and absolute discretion of the Bank. I have no right to object to the exercise of
discretion of the Bank.
10. I understand that the Bank is authorized to unilaterally delist me from the Bank’s list of accredited Home Loan brokers in case of breach of the Terms and Conditions of
this Undertaking or the Bank’s policies, commission of fraudulent acts or transactions.
11. I understand that I shall no longer be credited for approved and booked referrals after the date of my delisting. Furthermore, I shall no longer be credited for approved but
not yet booked/released referrals after the date of my delisting.
12. I understand that I shall be subject to review as often as deemed necessary by the Bank.
13. I hereby agree to indemnify and hold the Bank, its parent company, affiliates, subsidiaries and their respective officers, directors, employees, and representatives, free
and harmless from any loss, claim, damage, cost or expense of any kind including reasonable attorney’s fees that may arise as a result of my acts.
14. I shall conduct my business and regulate my operations in a way that will maintain and increase the goodwill and reputation of the Bank. I shall conform with and abide
by all laws, rules, ethics, regulations and procedures required by the Bank. I HEREBY AFFIRM AND CONFIRM THAT I HAVE CAREFULLY READ THE FOREGOING, FULLY
UNDERSTOOD THE CONTENTS THEREOF, AND HAVE FREELY AND KNOWINGLY SIGNED MY NAME HEREON ON THE DAY STATED BELOW.

Broker's designated personal Security Bank Broker applicant's signature Date signed
Checking/Savings/Cash Card account no.