2X2

AMOUNT APPLIED: LOAN PURPOSE:

PHOTO
LOAN TERM: 6mos. 12mos. 18mos. 24mos. OTHERS:
WALK IN REFERRED BY: (NAME OF LOAN ADVISOR)
LOAN PRODUCT:
CAR LOAN (SANGLA ORCR) Other:
DOCTORS LOAN
Submit the completed and signed application form (indicate N/A if Not Applicable) together with required documents. Processing of the application will start only upon submission of all
required documents.
BORROWER'S PERSONAL INFORMATION
LAST NAME FIRST NAME MIDDLE NAME BIRTHDAY (mm/dd/yy) AGE SEX: MALE
FEMALE
MARITAL STATUS: SINGLE MARRIED OTHERS: COURSE: SCHOOL:
FATHER'S NAME: AGE: MOTHER'S NAME: AGE: NATIONALITY:

NAME OF DEPENDENTS AGE SCHOOL (FOR EMPLOYED - EMPLOYER/ POSITION)

PRESENT ADDRESS: (HOUSE NO. / LOT / BLOCK / STREET/ VILLAGE / SUBDIVISION / BARANGAY / MUNICIPALITY / CITY / PROVINCE) NEAREST LANDMARK

RESIDENCE OWNERSHIP: OWNED MORTGAGED RENTED W/ RELATIVES HOME TELEPHONE NUMBER MOBILE NUMBER/S
MONTHLY RENTAL/ AMORTIZATION:
PERMANENT ADDRESS: LENGTH OF STAY: EMAIL ADDRESS:

PROVINCIAL ADDRESS: LENGTH OF STAY: FB ACCOUNT:

DO YOU OWN MOTOR VEHICLE? NO YES, HOW MANY: MAKE: MODEL: PLATE NO:
BORROWER'S SOURCE OF INCOME
EMPLOYMENT TYPE EMPLOYED SELF- EMPLOYED OTHERS:
EMPLOYER/ BUSINESS NAME: POSITION:
NATURE OF INDUSTRY/ BUSINESS: TOTAL YEARS AT WORK / IN BUSINESS:
OFFICE NUMBER: NUMBER OF EMPLOYEES / TOTAL MANPOWER:
BUSINESS START DATE: (IF SELF EMPLOYED) NO. OF YEARS WITH CURRENT EMPLOYER:
EMPLOYER/ BUSINESS ADDRESS: ZIP CODE:
OPERATING EXPENSE: GROSS ANNUAL INCOME: TIN NUMBER: __________
SPOUSE / CO- BORROWER'S PERSONNAL INFORMATION (IF APPLICABLE)
LAST NAME FIRST NAME MIDDLE NAME BIRTHDAY (mm/dd/yy) AGE SEX: MALE
FEMALE
BIRTHPLACE: MOTHER'S FULL MAIDEN NAME NATIONALITY:

SPOUSE / CO- BORROWER'S SOURCE OF INCOME (IF APPLICABLE)

EMPLOYMENT TYPE EMPLOYED SELF- EMPLOYE OTHERS:
EMPLOYER/ BUSINESS NAME: POSITION:
NATURE OF INDUSTRY/ BUSINESS: TOTAL YEARS AT WORK / IN BUSINESS:
OFFICE NUMBER: NUMBER OF EMPLOYEES / TOTAL MANPOWER:
BUSINESS START DATE: (IF SELF EMPLOYED) YEARS IN EMPLOYER:
EMPLOYER/ BUSINESS ADDRESS: ZIP CODE:
OPERATING EXPENSE: GROSS ANNUAL INCOME: OTHER ANNUAL INCOME:

BORROWER'S PERSONAL REFERENCE

NAME RELATION CONTACT NUMBER ADDRESS

BANK AUTHORIZATION FORM UNDERTAKING AND AUTHORIZATION

DATE:
This is to authorize FORBES LENDING SOLUTIONS CORP., or its authorized
representative to verify my/our Savings/ Checking Account with your bank. I/We hereby certify that all the data or information furnished in this Application Form are true,
correct and complete, and the signatures herein are true and authentic. I/We hereby authorized
FORBES LENDING SOLUTIONS CORPORATION, its subsidiaries or affiliates, to obtain, validated or verify
Bank Account No. Bank/Branch Account Type and, if necessary, hare, report or disclose such data or information and thereby waive my/our rights in
relation to confidentiality of account under RA9510 (Credit Information System Act), RA 10173 (Data
Privacy Act) and their implementing rules and regulations as well as other laws and issuances. I/We
agree that this application and all supporting documents and any other information obtained by
FORBES LENDING SOLUTION CORPORATION relative to this application shall remain as its property
irrespective of the granting of the loan. I/We further acknowledge that any false statement or
Thank you very much for your kind assistance. concealment of any information which may be discovered after loan has been granted shall be
sufficient basis for FORBES LENDING SOLUTIONS CORPORATION to consider the loan immediately due
Signature over Printed Name and demandable.

Signature of Borrower over Printed Name Signature of Spouse over Printed Name
Date: