Date: _______________________

MC QUEENS LOAN APPLICATION FORM New Borrower

Old Borrower
Instructions: Accomplish in print and make sure that you have filled-up everything correctly. If there are questions that are not
applicable to you just put “NA”.
PERSONAL INFORMATION
Last Name First Name Middle Name Maiden Name (if married)

Date of Birth (MM-DD-YY) Age Citizenship Civil Status Religion Sex

Present Address Owned/Rented? Mobile/Cellphone No.

Home Address Owned/Rented? Mobile/Cellphone No.

EMPLOYMENT INFORMATION
Name of Employer/Institution Nature of Business Address Telephone/Fax No.

Designation Employment Status Length of Service Monthly Gross Salary

FAMILY BACKGROUND
Name of Spouse (if married) Age Date of Birth (MM-DD-YY) Citizenship Religion

Occupation of Spouse Spouse’s Employer Employer Address Length of Service Monthly Gross Salary

Name of Dependents Age Civil Status Educational Level Occupation/Employer

LOAN APPLICATION DETAILS

Amount of Loan Purpose of Loan Term Mode of Payment
Quincena [ ] Monthly [ ] Lumpsum [ ]
Primary Source of Payment Other Sources of Payment
Salary Bonus Pension Others Pls. Specify:
Pls. Specify _________
ADDITIONAL INFORMATION(Please mark your responses. Use additional sheets if necessary.)
1. Have you ever been found guilty or been penalized for any offense or violation involving moral turpitude or carrying the penalty? If
yes, please check nature of offense, and specify name of court or administrative board and disposition of case:
YES NO
Administrative Provide
Civil details:
Criminal
YES NO 2. Have you ever been suspended, discharged or forced to resign from any of your previous positions? If yes, provide details:

YES NO 3. Do you have a residence or any relatives residing abroad?

4. Do you have a credit card
or an existing loan? If yes, 1.
YES NO give details: 2.
3.

REFERENCES (Do not include relatives.)

Name Designation Address Contact Details

I hereby certify that the statements made by me are true, complete, accurate, and correct to the
best of my knowledge and belief. Any false information contained herein may serve as grounds for rejection
of my loan application or cancellation of its approval. This likewise serves as an authorization to conduct
investigation on my personal background.

I further certify that the proceeds of the loan, if this application is approved, will be used solely for
the purpose stated in the application.

Referred by:

Applicant’s Signature over Printed Name