LOAN APPLICATION FORM

RISE UP Micro Multi-purpose Loan Program

BORROWER’S INFORMATION
Last Name: IBON First Name: JOSEPH RUSSEL Middle Name: ATIENZA

Suffix: Date of Birth: 11/02/1993 Sex: Male Female

Mobile No.: (0931) 9872615 Landline No. E-mail Address: amberibon21@gmail.com

IDENTIFICATION DOCUMENT
Government-issued ID: GSIS UMID I.D. No.:
RESIDENTIAL ADDRESS
045 BLK 28 MOLAVE AT PINAGBUHATAN
House/Lot No., Street Name, Subdivision Barangay
CITY OF PASIG METRO MANILA (2ND DISTRICT) NATIONAL CAPITAL REGION (NCR)
City/Municipality Province Region

BUSINESS INFORMATION
Business Name: JOCELINA IBON'S VEGETABLE STORE

Business Address: Same as residential address of the borrower Not same as residential address of the borrower
(Supply this only if different from residential address provided above)
LOT 1,BLOCK 06 KENNETH RD SANTA ANA
House/Lot No., Street Name, Subdivision Barangay
TAYTAY RIZAL Region IV-A (CALABARZON)
City/Municipality Province Region

Estimated Asset Size: 300000

(Excluding land)

REQUESTED LOAN TERMS

Loan Amount: PhP 300,000 Loan Tenor: 36

Grace Period: 12

LOAN RELEASE DETAILS

PAYMAYA PHILIPPINES, INC. JOSEPH RUSSEL IBON 09319872615
Bank/EMI Name Account Name Account No.
CHECKLIST OF REQUIREMENTS
A selfie of the loan applicant holding a valid ID clearly One (1) valid ID of the loan applicant
capturing both the loan applicant’s face and valid ID

For corporations: Latest General Information Sheet For partnerships: Articles of Partnership
One (1) minute video showing the financial condition and Three (3) photos showing the following: 1) business signage; 2)
assets of the business. inventories; and 3) fixed assets
For loans up to PhP100.0 thousand: current or previous year’s Barangay Permit; or

For loans above to PhP100.0 thousand:current or previous year’s Mayor’s Permit or Barangay Micro Business Enterprise Certificate

Proof of bank account or e-money account.

UNDERTAKING/ DECLARATION
I/We hereby confirm that all information and supporting documents provided herein are true, accurate and complete and I/we
agree to notify the Small Business Corporation (SBCorp) of any changes in any of the information supplied. I/We further
authorize SBCorp to verify and validate all information and supporting documents that I/We submitted to SBCorp before all the
concerned government agencies (DTI, BIR, SEC, and LGUs). In the event that, SBCorp upon verification with the concerned
government agencies discovers that any and/or all information or supporting documents submitted is/are
inaccurate/false/fraudulent, I/We acknowledge that SBCorp can withdraw or cancel any loan approval issued in my/our favor.

I/We authorize SBCorp to obtain relevant information as it may require concerning this application. I/We hereby agree that this
application shall be subject to applicable laws (BSP circulars, rules and regulations) and policies of SBCorp.
DATA PRIVACY CONSENT
In compliance with the requirements of the Data Privacy Act (DPA), I/we hereby authorize and give my/our consent to Small
Business Corporation (SBCorp) on the general use and sharing of information obtained in the course of my/our transaction. Any
disclosed information, including personal and sensitive information may be collected, processed, stored, updated, or disclosed
by SBCorp on the following purpose:
a. For legitimate purposes and requests;
b. To implement transactions which the borrower requests, allows, or authorizes; and;
c. To provide new and related products and services of SBCorp; and
d. To comply with the SBCorp’s internal policies and its reporting obligations to the government authorities under
applicable news.
I/ we certify that all provided information is correct and true to my /our knowledge. Any false information and
misrepresentation made in this document shall cause the filing of administrative/criminal case/s against me/us. I/We authorize
SBCorp to verify/validate the information and supporting documents I/We submitted to SBCorp before the concerned
government agencies (DTI, BIR, SEC, and LGUs). Moreover, I/we confirm and recognize that SBCorp or their credit delivery
partners and service providers may disclose collected information or any basic credit data including related changes or
correction on the data in Credit Information Corporation (CIC) and other authorized entities as stated in the Credit Information
Act of 2002 (R.A. 9510).

JOSEPH RUSSEL ATIENZA IBON 12/27/2022

Signature under Printed Name (Borrower) Date

Signature under Printed Name (Co-borrower) Date