C.

A CODE:A

FORD MARILAO Credit Application

Sales Consultant: JOHN CHRISTIAN LIBIRAN
SOS: email: Sales Manager: JAYSON DE LUNA
PERSONAL INFORMATION

Borrower's Name: Butch Yap Date of Birth: 09-15-1981

Vengua
First Middle Last mm dd yy

Civil Status: Single x Married Widowed Separated No. of Dependents: 1

Nationality: X Filipino Others: (Pls. Specify) _______________________________ Gender: X Male Female

Home Home no.

Manikan St. Near Bangko Zambalenyo ,South Pob.
Address:
Mobile No.: +966561556257

Provincial Other No.:

Masinloc, Zambales, Philippines
Address:

Residential Status: Owner (Mortgaged) Owner (Not Mortgaged) Taxpayer's ID No.:

X
Owned Car: Yes, If so, how many? No
X
Bank/ Branch: PNB- IBA,Zambales Branch Account Number: Upon C.I.

WORK EXPERIENCE

Employment: Private Sector Government X Self-Employed Position / Title: Machine Operator

Tetra Pak
Employer / BusinesFILCROFT INC.Company Business Tel.:

Business Address: Jeddah, Saudi Arabia Mobile No.:

Nature of Business: Length of Stay: 10 yrs 9 Mos.

OTHER SOURCE OF BUSINESS: Monthly Income: 7,046 Saudi Riyal

SPOUSE PERSONAL DETAILS

Spouse name: Jeannette Mendoza Vengua Date of Birth: 07 14 1977

First Middle Last mm dd yy

Employment: X Position / Title: Medical Technologist

Employer / Business:
Intenational Medical Center Business Tel.:

Business Address: Jeddah, Saudi Arabia Mobile No.: +966566778610

Nature of Business: HOUSEWIFE Length of Stay: 13 yrs 0 Mos.

Monthly Income: 7,700 Saudi Riyal

CO-MAKER PERSONAL DETAILS

Co-Maker Roel Elgar Vengua Date of Birth: 03 05 195

COMMONLAW First Middle Last mm dd 7 yy

Employment: Private Sector Government Self-Employed Position / Title:

Employer / Business: Business Tel.:

Home Address 4A Rosario St , Masinloc, Zambales ,Philppines Mobile No.: +639391355749

Nature of Business: Length of Stay: yrs Mos.

Monthly Income:

PERSONAL / TRADE REFERENCES

Name Address Telephone Number

VEHICLE DETAILS

Make / Model: Cash Price: Downpayment:

Amount Finance: Terms: Months:

I / we certify that all above informations are true and correct to the best of my knowledge. I / We also hereby authorize and give my consent to
ANC GROUP OF COMPANY or FORD MARILAO and its accredited third- party partners to collect, store and process and share my information
provided that such collection, storage and processing and sharing are in accordance with the provisions of Republic Act No. 10173 or the
Data Privacy Act of 2012, its implementing Rules and Regulations and other Laws, rules and regulations relating data privacy.

Signature of Borrower Date Signature of Spouse / Co-Maker Date