Date: ____________________

Request for Statement / Certification / Payment of Processing Fee and Authorization to Debit

This is to request for the ff. documents for Business Loan of ______________________<Account Name> with the Loan Account Number
(LAN) _______________________________ for the purpose ____________________________________________.

Type of Request Fees

Statement of Account to Fully Pay / Partially Pay

Free
Computation of the amount needed to be paid. Amount as of _________________
Certificate of Full Payment
Php 200
Certification that the loan has already been paid and closed in Bank's record
Certificate of Balance
Php 200
Certification of loan details, loan term and collateral description. Balance as of ________________
Amortization Schedule
Php 200
Statement indicating future amortizations due and application to interest and principal
History of Payments
Php 200
Statement indicating all previous loan payments or amortization. For period ___________________
History of Application of Payments Php 500 (max. of
Detailed Statement indicating all previous payments and application to interest, principal and other 5 PNs/Loans)
fees (max of 3 years). For period _____________________ Php 1,000 (> 5
PNs/Loans)
Certificate Interest Paid
Certificate indicating interest paid and outstanding principal balance for a specific period, used for Php 200
BIR reporting purposes. For period ______________________
Change of Due Date
Php 500
Requesting to change the due date of term loans. Processing fee + Interest Differential
Rate Reduction
Php 3,500
Requesting to reduce loan's current interest rate based on existing guidelines
Certified True Copy / Photocopy of Loan Documents Php 100 /
Certified true copy of loan-related documents including mortgage loan agreement etc. document

Others, please specify ___________________________________________

I/We hereby consent the Bank’s disclosure of information relative to my/our loan by virtue of the documents and certifications issued upon my/our request.
The consent given shall be the consent required under the applicable bank secrecy and confidentiality laws, as well as data privacy laws, in the Philippines.
Further to this, I/We hereby release the Bank, its directors, officers, employees or agents from whatever liability that may arise from such disclosure.

This is to authorize the Bank to debit the corresponding processing fee from my BPI / BFSB Savings or Current Account
Number: _____________________________________________________________ for payment of charges for my/our
request including all applicable fee/s subject to the terms and conditions above.

_________________________________ _________________________________
Signature over Printed Name / Date Signature over Printed Name / Date
Borrower / Co-Borrower Authorized Representative / Signatory
Valid ID no:________________________ Valid ID no:________________________

Signature verified by: _______________

Date verified: _____________________
BB Form ver 071819