R&V INSTA CASH MICROFINANCE, INC.

POBLACION, SAN ILDEFONSO, BULACAN 3010

APPLICATION FORM

NAME:______________________________________DATE:_____________________ 2X2
ADDRESS:____________________________________AGE:______________________
BIRTHDAY:___________________________________GENDER:___________________
CELLPHONE NO.:______________________________CIVIL STATUS:______________

NAME OF SPOUSE:_____________________________________ NAME OF CHILDREN AGE

AGE:_________________________________________________1._________________________________ ________
BUSINESS/WORK:______________________________________2._________________________________ ________
AMOUNT LOAN:_______________________________________ 3._________________________________ ________
4._________________________________ ________

BUSINESS:___________________________HOME: OWNED RENTAL KABUUANG KITA

YEARS:_____________________________ YEARS:_____________________________ MEMBER:_________
SPOUSE:__________
TOTAL:___________

AKO SI ____________________, NAKATIRA SA _________________________________________, AKO

PO AY NANGHIRAM SA (A&V INSTA CASH MICROFINANCE, INC. SA HALAGANG _________, AT PUMAPAYAG NA ITO
AY MAY INTEREST NA ___% KADA BUWAN (MONTHLY) AT NANGANGAKONG MAGBABAYAD AT TUTUPAD SA ARAW
AT ORAS NA ITINAKDA SAAMIN.
GAGAMPANAN KO PO ANG AKING OBLIGASYON KATUWANG SINA _____________________________
AT___________________________SA LOOB NG _______WEEKS (4MONTHS). (ASAWA)
(CO-MAKER)

____________________________________ ________________________________ ________________________

MAKER (SIGNATURE OVER PRINTED NAME) SPOUSE (IGNATURE OVER PRINTED NAME) CO-MAKER
(SIGNATURE OVER PRINTED NAME)

__________________________________________________________________________________________________
CHECKED BY CENTER CHIEF APPROVE BY

____________________________________ ____________________________________
C.I SIGNATURE OVER PRINTED NAME DATE OF C.I

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