PERSONAL LOAN APPLICATION FORM

Amount Applied For: Purpose of Loan: Term of Loan: 12 months 24 months 36 months Requirements: Latest ITR Latest 1 month pay slip and COE Photocopy of a valid I.D. w/ 3 specimen signatures Proof of Billing Gender: Separated Widowed Male Female Owned Owned-Mortgaged Living w/ Relatives Rented Dependents: Mothers Full Maiden Name

First Name TIN:

Middle Name

Last Name SSS /GSIS No:

BORROWERS DATA Marital Status: Married Single Years of Stay:

Present Address (House No, Street, Subdivision, Bldg.Name,City/Municipality) _________________________________________________________________ _________________________________________________________________ Permanent Address: Citizenship Birthday (dd-mm-yyyy) Age: Birthplace: Highest Educational Attainment: High School Graduate College Undergraduate College Graduate Post Graduate Present Employer Private Government Office Address: (Floor, Bldg. Name, Street, City) _________________________________________________________________ _________________________________________________________________

Home Telephone No/s: Cellphone No: Email Address:

Length of Stay:

Years w/ Previous Employer:

Position: Permanent Probationary Contractual Email Address: Age Status:

Office Telephone No (including Local No.): Fax No:

Name of Spouse (First Name, Middle Name, Last Name) Spouse's Employer Spouse's Employer Business Address Private Government

Citizenship Position

Birthday (dd-mm-yyyy) Length of Stay Cellphone No:

Office Telephone No (including Local No): CREDIT CARD

Bank

Credit Card No.

Credit Limit

Expiry Date

Bank-Branch

BANK ACCOUNTS Type of Account Account No.

Year Opened

Bank/Company

LOANS WITH OTHER BANKS/ INSTITUTIONS Outstanding Balance Monthly Amortization

Loan Type

Name

PERSONAL REFERENCES Address Relationship

Telephone / Cellphone No/s

INCOME & FINANCES Gross Monthly Income: Applicant Spouse Total Less: Monthly Expenses Taxes, SSS & other deductions, Living Expenses Rent Education Amortization Credit Cards Insurance NET INCOME

AUTHORIZATION:
I hereby certify that all information I furnished in this form are true and correct. Should said information furnished herein be found to be false, the bank may disapprove this application and/or declare the loan to be due and demandable (in case the loan proceeds have already been released). Premiere Development Bank and its authorized representative/s are hereby authorized to validate the information provided in this form from our employer, personal references, banks and other such sources. Person/s identified in this form are hereby authorized to provide information/documents required in connection with this application. I fully understand that loan release shall only be allowed once all requirements of Premiere Development Bank are complied with. Premiere Development Bank is also hereby authorized to fill-up the necessary information required in the Promissory Note and the Disclosure Statement, both of which I have signed herein, including the date, amount of the loan granted to me, and the interest rate in accordance with the Bank's applicable policies and the approved terms and conditions of the loan. In case of disapproval of this application, I understand that the Bank is not obliged to disclose the reason/s for such disapproval. In the event of future delinquency, I hereby authorize the Bank to report and/or include my name in the negative listing of any credit bureau or institution.

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___________________________ Name and Signature of Applicant TO BE FILLED OUT BY REFERROR / AGENT Date Code Branch/Agency Name Referror/Agent Name
"PLEASE MAKE PAYMENTS ONLY TO AUTHORIZED PREMIERE BANK EMPLOYEES. SALES AGENTS AND/OR REFERRORS ARE NOT ALLOWED TO COLLECT ANY FEES OF WHATEVER NATURE ON BEHALF OF PREMIERE BANK"