Académique Documents
Professionnel Documents
Culture Documents
CONFIDENTIAL
Name of Applicant
Date of Application
This form will help us in evaluating your application as a potential co-venture associate. Please answer
all questions completely and accurately.
www.flyingv.com.ph
Attach 2x2 pic
PERSONAL INFORMATION
Last Name Given Name Middle Name Gender
F M
Birthplace Citizenship
Age Birthdate (mm/dd/yyyy) Civil Status Single Widowed
Height Weight
_____ / _____ / _____ Married Separated
No. of Dependents Mother's Maiden Name E-mail Address FB / Social Media Account
Skype ID
Home Telephone No. Mobile No. Tax Identification No. SSS / GSIS No.
BUSINESS/EMPLOYMENT INFORMATION
Business Name/Employer's Name Nature of Business Rank / Position Title
DTI Registration No. Expiration Date Office Mobile No. Office Landline & Fax No. Office Email Address
Type of Products / Services Product's Brand Name No. of Equipments Type of Equipments
Sales Volume Weekly basis/salary Monthly basis/salary Estimated Gross Margin/Month Type of Customer
PHP ______________ PHP ___________ Retail Wholesale
TRADE REFERENCES
Major Customers Contact Person / Position Contact No.
Are you related or by affinity to an employee of Flying V, TWA, Yes If yes, who?
FVRNC or any RFV Allianz affiliate?
Department and
No
Position
FAMILY BACKGROUND
Name Age Occupation Complete Address Contacts/Mobile No.
Father
Mother
Siblings (eldest to youngest)
Post Graduate
College/ Vocational
High School
Elemenetary
Driver’s License
Passport
Unified ID System
Other ID available
Social activities
List all civic, social, business organization or clubs you are an active member of:____________________
_____________________________________________________________________________________
What type of relationship do you have with your family? How does this affect your outlook in life?
SUMMARY OF ASSETS & LIABILITIES
CASH IN BANKS
Date
Deposit Type Bank/Branch Account Number Balance Annex
Opened
Peso Checking Account
Peso Savings Account
30-day Peso Time Deposit
Dollar Savings Account
Others, pls specify
TOTAL
INVESTMENTS
Account/Certificate Date
Investment Type Bank/Branch Balance Annex
Number Opened
Long-term Peso Time Deposit
Long Term Dollar Time Deposit
Date
Investment Type Issuer/Type (Preferred or Common) Certificate Number Par Value Annex
Acquired
Bonds
Stocks
Others, please specify
TOTAL
REAL ESTATE PROPERTY
TCT No. Location Lot Area Floor Estimated Value If Mortgaged, Mortgagor Remaining Annex
Area amount of Monthly Balance
Amortization?
TOTAL
MOTOR VEHICLE
If Mortgaged, Mortgagor Remaining Balance Annex
Year Plate Estimated amount of
Type of Motor Vehicle
Model Number Value Monthly
Amortization?
TOTAL
TOTAL
TOTAL ASSETS
LIABILITIES (LOANS)
Type of Loan Bank/Financial Institution Monthly Amortization Outstanding Balance Annex
Car Loan
Housing Loan
Business Loan
Personal Loan
Salary Loan
TOTAL
CREDIT CARD/S
Credit Card Company Card Number Member Since Expiry Date Outstanding Balance Annex
TOTAL
TOTAL LIABILITIES
NET WORTH
CASH FLOW SUMMARY Monthly Annualy REMARKS
Cash Inflow GROSS NET GROSS NET
Income from Salary
Spouse's Salaray
Business 1
Business 2
Business 3
Other Inflow
TOTAL INFLOW
Cash
Outflow
Expenses
UTILITIES
Electricity
Monthly Dues
Water
EDUCATION
Education (1st child)
Education (2nd child)
HOME EXPENSE
Househelp
Groceries
OTHERS
Medical Expenses
Gasoline
Cable
Internet
Cellphone
Others: Identify
Amortization
Home Amortization
Car Amortization
TOTAL OUTFLOW
NET CASH
Personal References
Name Address Business/ Occupation Contact no.
Professional References
Name Address Business/ Occupation Contact no.
Health
Do you have any physical handicaps or special precautions and worries about health that would be
shown by a medical examination? (For example: hearing, eyesight, foot ailments, rupture, allergies, lung
or heart condition, stomach condition, headaches, arthritis, sinus, asthma, affected by fumes or cold.)
Have you had any illness during the last five years that required the services of the physician?
Declaration
I hereby certify that the information given by me is true and correct to the best of my knowledge and
that any material misrepresentation or falsity may be grounds for termination of my
contract/agreement with Flying V. I hereby authorize Flying V to inquire about and investigate all the
declared information from whatever sources Flying V may consider appropriate and to disclose any
information herein provided to any person or entity. For this purpose, I agree to indemnify and hold
Flying V free and harmless from any and all claims, liabilities, damages, suits or causes of action of
whatever nature, now or hereafter arising from or in connection with the foregoing authorization.
__________________________________ _____________________
Signature of applicant over printed name Date