SALARY LOAN APPLICATION FORM  NEW  RENEWAL

Amount Applied:
Referred By:

BORROWER’S PERSONAL INFORMATION 2x2

Last Name First Name Middle Name Birthday
(mm/dd/yy)
Age Sex:  Male
 Female
PHOTO

Marital Status:  Single  Married Others: Course: School:

Father’s Name: Age: Mother’s Name: Age:

CHILDREN (SIBLINGS IF SINGLE) 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  With Relatives Home Telephone Number Mobile Number/s
Monthly Rental / Amortization:

Permanent Address Length of Stay: Email Address

Provincial Address Length of Stay: FB Account:

BORROWER’S EMPLOYMENT INFORMATION

Company Name  Main Office Basic Salary:
 Branch:
Company Address (Unit/Floor/Building/Street/Village/Barangay/Municipality/City/ Province)/HR Contact Person & Position Net Salary:

Company Tel. No Position Years Employed SSS No. TIN Status: Contractual
 Permanent
SPOUSE’S INFORMATION
Last Name First Name Middle Name Birthday(mm/dd/yy) Age Gender:  Male
 Female
Educational Attainment: Course Taken: School/University: Contact Number:
 High School  College  Post-Graduate
Employment:  Self-Employed  Government Employer/Business Name Nature of Business
 Private  Professional
Employer/Business Address (Unit/Floor/Building/Street/Village/Barangay/Municipality/City/ Province) Length of Stay/Yrs. Employed

Position Gross Income Net Income SSS No. TIN No. Status: Contractual
 Permanent

FOR FLSC USE ONLY

Amount Approved - Monthly Amort.
Terms
Remarks
CASH FLOW:
Monthly Income Amount Expenses Amount Remarks/Comment
Net Salary Food
Incentives/Comm. Utilities
Spouse Income Education
Other Income Rental/Amort.
Transpo./Gas
Others
TOTAL TOTAL
NET INCOME
AO’S Remarks:

Employee Verification

UNDERTAKING
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 authorize FORBES LENDING SOLUTION CORPORATION, its subsidiaries or affiliates, to obtain, validate or verify and, if necessary, hare, report or
disclose such data or information and thereby waive my/our rights in relation to confidentiality of accounts under RA 1405, and privacy of credit data or other data or
information pertaining to me/us or my/our accounts as may be necessary or for FLSC to comply with RA 9510 (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 concealment of any information which may be discovered after the loan has been granted shall be sufficient basis for
FORBES LENDING SOLUTION CORPORATION to consider the loan immediately due and demandable.

Borrower (Signature over Printed Name) Date Spouse (Signature over Printed Name)