Customer Request Form

CLG - Service Fulfillment Unit

Secured Loans

Client / Account Name Date

1.
Loan Account Number Home Tel. No. 2.
1.
Address Office Tel. No. 2.

1. 1.
E-mail Address 2.
Mobile No. 2.

Please check ( ) type of request:

Auto Loan Business Mortgage Loan Home Loan Source (Branch Name, Unit) ___________________________________

Amortization Schedule Copy of Loan Documents (Please specify) ___________________

ADA Replacement / ADA Enrollment (Requires ADA Form) Refund (Release Mode)
Manager’s Check
Certification (with Certificate Charge of P100.00 - 1st two years of extraction of info Credit to CA / SA no. _____________________
P200.00 - more that two years)

Payment Summary / History of Payments

Outstanding Balance Release Collateral Documents
Interest Applied and Total Interest Paid
Full Payment (No Charge) Post Dated Check Related (Please indicate reason on the remarks field)
(Please specify coverage period) _____________________________
Hold Pull Out Replacement Re-Deposit/Deferment
from __________ to _________
(date) (date)
(Please specify reason & check details) __________________________________________
Certificate of Encumbrance with OR / CR (For Auto Loans only)

Statement Account for Full Payment

Certificate of Mortgage Collateral (For Home Loans only, with P100 Fee) As of (pay-off date) _______________________

Change Due Date Update / Change Customer Information

From ___________________ To ___________________________ Old Info;___________________________________________________________

(Please specify reason) ________________________________ New Info;__________________________________________________________

Change Mode of Payment

Others (Please specify) ___________________________________________
ADA to PDC PDC to ADA (Requires ADA Form)
___________________________________________________
Change ADA Paylink (Requires ADA Form)

I hereby acknowledge having made the above request for th reason/remark stated, and further authorize BDO/its representatives to send
requested documents via:

Facsimile to Fax Number _________________________________________ Email to (Email address) _________________________________________

Mail Delivery to (Address) _________________________________________ Branch Delivery (specify branch) __________________________________

Others ___________________________________________________________ Pick-Up at SFU Secured office _____________________________________

I also authorize BDO/its representatives to give feedback and/or update regarding my request through the contact numbers and
information I have submitted to BDO, or on file with BDO. BDO/its representatives shall be free from any claim or liability whatsoever, in
case the requested document/s (and the contents thereof) is/are received by or has/have come to the possesion or knowledge of any
third person, whether authorized or not authorized by the undersigned.

PLEASE For Banks Use Only

SIGN HERE Verified by:
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Signature of Client over Printed Name (Signature over Printed Name) Identification Card Presented
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Copy 1 – SFU Copy 2 – Client Copy 3 – Source

Service Fulfillment Unit - Secured Loans

5th Floor, JMT Corporate Condominium, Ortigas Center
Version3/April2010
BDO Customer Contact Center: 631-8000