CODE: 0339 New Loan

Registry No. Reloan

SALARY LOAN APPLICATION FORM Voucher No. Multiple
Date:
Instructions: PLEASE PRINT ALL INFORMATION LEGIBLY IN CAPITAL LETTERS. Indicate N/A in the fields which are not applicable.

I hereby apply for a loan in the amount of PESOS: _______________________________________________________________________________________ (P_____________________) for the following purpose:

Training/Education Home Renovation Others (please specify) ____________________________________

Household
Medical Loan Buyout
Consumption/Needs
for a term of: _________________________ months, which I promise to pay in accordance with the rules, regulations, terms and conditions of CITY SAVINGS BANK as stipulated in this application form, the Promissory Note of
even date, and such other documents executed together with this loan; all of which I certify to have read and understood clearly.

PERSONAL INFORMATION

Client Name (Last Name, Given and Middle Name) Single Married
Civil Status
Widowed Separated
Date of Birth
Birth Place Sex Male Female
(mm/dd/yyyy)

Age CTC No. Mobile No.

Nationality GSIS/SSS No. Res. Tel. No.

Email Address TIN

Present Address (No./Street/Village/Barangay/District/Municipality/City/Town/Province) Zip Code

Owned Living with Parents Company Quarters Mortgaged Length of Stay ______ Years ______ Months
Ownership
Living with Relatives Rented Others (specify): ___________________ Res. Tel. No.

Permanent Address (No./Street/Village/Barangay/District/Municipality/City/Town/Province) Zip Code

Owned Living with Parents Company Quarters Mortgaged Length of Stay ______ Years ______ Months
Ownership
Living with Relatives Rented Others (specify): ___________________ Res. Tel. No.

EMPLOYMENT INFORMATION
Name of
Office Tel. No. & Local
Employer/School
Address of
Office Mobile No.
Employer/School

Source of Fund Employee No. Office Email Address

Position Div Code Basic Monthly Salary PHP

Monthly Recurring
Nature of Work Reg Code PHP
Allowance

Employment Status Station Code Date Hired

SPOUSE INFORMATION (IF APPLICABLE)

Spouse’s Name (Last Name, Given and Middle Name) Date of Birth

Birth Place

Employer/Business Age

Position Mobile No.

Nature of Work/ Business Monthly Income USD/PHP Email Address

IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR SALARY LOAN AND BANK: UnionBank CitySavings
ANY REFUNDABLES THAT IS DUE TO ME, I HEREBY AUTHORIZE CITY SAVINGS
BANK TO CREDIT THROUGH MY GSIS – UNIONBANK UMID/ECARD OR
CITYSAVINGS SAVINGS ACCOUNT (SA22). Signature over Printed Name of the Borrower Account #:

PRIVATE INFORMATION PROVISIONS FOR LOAN APPLICATION

The loan applicant (“Borrower”) acknowledges and agrees that, in the course of his/her loan application with
City Savings Bank, Inc. (“CitySavings”), and throughout the term of his/her loan if such loan application is
granted, CitySavings may receive or have access to Personal Information and/or Sensitive Personal
Information and/or any financial information of the Borrower which CitySavings may consider as relevant in
evaluating the loan application (hereinafter collectively referred to as “Private Information.”) Borrower
expressly consents to the processing, collection, transmission, storage, disposal, use and disclosure of
Private Information by CitySavings for the following purposes:
(c) to any consultant, adviser, auditor, counsel, agent, contractor or sub-contractor of CitySavings performing
services for the purpose of assisting or rendering services to CitySavings in the administration or promotion of its
lending business;
(d) to any person to whom CitySavings proposes to assign or transfer of its rights and/or duties to the loan;
(e) to any guarantor or person providing security in relation to Borrower’s obligation;
(f) as required or permitted by law, regulation, court or any regulatory authority; or
(g) as otherwise considered necessary or appropriate by CitySavings.

(a) to manage Borrower’s account(s), including endorsement to outsourced collections service provider in
case of default, any consultant, adviser, auditor, counsel, agent, contractor or sub-contractor of CitySavings
performing services for the purpose of assisting or rendering services to CitySavings in the administration or
promotion of its lending business;
(b) to confirm, update and enhance CitySavings’ records;
(c) for statistical analysis, internally by CitySavings and/or any service provider it may engage for the
purpose;
(d) to establish any identity or otherwise as required under applicable legislation;
(e) to assess Borrower’s credit status on an on-going basis;
(f) for marketing and promotional of CitySavings products; or
(g) any other purpose, as considered necessary or appropriate by CitySavings
In each case, the processing of Private Information may continue after the termination of the loan
agreement. CitySavings may disclose the Borrower’s Private Information:
(a) to a credit reference agency where it may be accessed by other financial institutions to assist assessment
of any application for credit made to CitySavings and for debt tracing and fraud prevention;
(b) to its parent company or any of its affiliate or subsidiary;
CONFORME: ____________________________________________
“Personal Information” as used herein means information provided to CitySavings by or at the direction of
Borrower, or to which access was provided to CitySavings by or at the direction of Borrower wherein: (i) the
identity of an individual is apparent or can be reasonably and directly ascertained; or (ii) when put together with
other information, would directly identify an individual.
“Sensitive Personal Information” as used herein means any Personal Information that: (i) pertains to an
individual’s race, ethnic origin, marital status, age, color, and religious, philosophical or political affiliations; (ii)
pertains to an individual’s health, education, genetic or sexual life, or to any proceedings in court; (iii) is issued by
government agencies peculiar to an individual, e.g., social security numbers and health records; or (iv) is
specifically established by an executive order or an act of Congress to be kept classified.
Furthermore by signing this form, the Borrower understands and expressly waives his/her right under
confidentiality laws including but not limited to RA 1405 or The Law on Secrecy of Bank Deposits, RA 6426 or The
Foreign Currency Deposit Act and RA 8791 or the General Banking Law and their respective implementing rules
and regulations and allow processing, storing, access to or sharing of any information regarding the
aforementioned Salary Loan as well as the Bank products, services and channels which the Depositor has
activated, enrolled in or availed pursuant to this Form.

Signature over Printed Name of the BORROWER

——————————DO NOT WRITE BELOW THIS SPACE-FOR CITYSAVINGS USE ONLY——————————

Complete required
RPSU AUTONOMOUS Newly hired with permanent appointment
documents
NET PAY VALIDATION: (3 mos. Latest Original Payslips) LOAN INFO REDEMPTION

1. Month Php Branch Name: PLI Name: Php

2. Month Php Branch SOL ID: PLI Name: Php

3. Month Php Scheme Code: PLI Name: Php

Group Code: SERVICING

 Branch Name Scheme Code:

Application received and verified by: Date:

LOAN COMMITTEE:

Date Received

Remarks AMOUNT APPROVED

Ph
p
only

TERM (in months)

Name
Ph
We recommend a loan of P p
Date:

be granted for a period of / months

Recommended by:

REFERRER’S PERSONAL INFORMATION (OPTIONAL)

REFERRER (1)
Employee No./ID
Name in Print: Contact No.:
No.:
REFERRER (2)
Employee No./ID
Name in Print: Contact No.:
No.:
REFERRER’S CONSENT
Referrer consents to the processing of personal information by the City Savings Bank,Inc., its directors, officers, employees, advisers, consultants, auditors, agents and representatives for purposes of (i) carrying out,
management, performance and development of its products and services (ii) pursuit of its marketing; promotional, communication, commercial and research objectives;-(iii) usual business transactions and (iv) compliance
with the requirements of applicable laws and/or government regulators or supervisory bodies. This constitutes as express consent under the applicable confidentiality and data privacy laws of the Philippines given, by the
Referrer specifically allows the,City Savings.Bank, Inc. to:

(a) collect, use, record, store, consolidate, retrieve, and process ("process") of Information;
(b) outsource the processing of Information to service providers wherever located.
(c) verification or validation of Information from any and all sources and In any reasonable manner
(d) disclose and share the information or data to:

(i.) City Savings Bank, Inc., Union Bank of the Philippines, Petnet;inc., Aboitiz Equity Venture and respective subsidiaries, affiliates and; related interests {the "Aboitiz;Group");
(ii.) service providers outsourced by the Bank ;
(iii) such other persons or entities that the Bank or any member of the Aboitiz Group, may deem necessary to perform the above activities.

Shall hold the CitySavings,Bank,lnc. and each member of the Aboitiz Group, free and harmless from any and all liabilities, claims, damages and suits of whatever kind and nature, that may arise" in connection with the
performance of the activities related with the authorization conferred by the Referrer hereunder.
CONFORME: ____________________________________________

Signature over Printed Name of the REFERRER (1)

CONFORME: ____________________________________________

Signature over Printed Name of the REFERRER (2)

SIGNED IN THE PRESENCE OF (CITYSAVINGS USE ONLY)

Signature over Printed Name Signature over Printed Name

For complaints, you may do either of the following: approach the Consumer Protection and Assistance Officer of the day in the branch where you did the transaction, text hotline 0917-8746753 or email to simpleisgood@citysavings.com.ph. Rest
assured that we will address them the soonest possible time.