CCU FINANCIAL LOAN APPLICATION FORM

Date Submitted: PURPOSE OF LOAN [ ] Emergency Loan [ ]Appliance [ ]Home Improvement [ ]Tuition fee [ ]Travel [ ] Others __________________________ CIVIL STATUS [ ]Single [ ]Widowed [ ]Married [ ]Separated

AMOUNT APPLIED FOR: (Min. P 1,000.00)

TERM OF LOAN [ ] 7 days [ ] 30 days [ ] 14 days [ ] 60 days

BORROWERS DATA SURNAME CITY ADDRESS: [ ]Rented [ ]Owned Res. Tel. No. Cellfone No. GENDER: [ ]Male [ ] Female

NAME

MIDDLE NAME

PROVINCIAL ADDRESS Length of Stay ________ months Office Tel. No. Email Add: CITIZENSHIP [ ] Filipino [ ] Other ___________ ACR No. _____. NAME OF SPOUSE OR CO-MAKER BIRTHDATE:(mm/dd/yyyy) EMPLOYER/ BUSINESS ADDRESS NO. OF DEPENDENTS:

EMPLOYER / BUSINESS NAME Position: Tenure (years): SPOUSE OR COMAKER'S EMPLOYER/BUSINESS NAME Position: Tenure(years): BORROWER'S ID SSS/GSIS No. ___________________ TIN No. _____________ CREDIT CARD DETAILS Credit Card Issuer

SPOUSE OR COMAKER'S EMPLOYER/ BUSINESS ADDRESS

CO-MAKER'S INFO SSS/GSIS No. ___________________ TeL. No. __________________

Credit Card Number

Credit Limit

Expiry

No of yrs member

LOANS WITH OTHER BANKS/INSTITUTIONS Bank/Company Outstanding Balance/Rem Years

Monthly Amort

Loan Type (e.g. housing/ auto)

PERSONAL REFERENCES Name Address 1. 2.

Relationship

Tel. No.

Cell No.

NET INCOME Applicants Mo. Salary/Income Spouses Mo. Salary Other Sources of Income Total Monthly Income Less : Mo. Expenses Rent Expense Net Income FOR CCU FINANCIAL USE ONLY CREDIT STATUS [ ] Approved [ ] Declined Loan Amount: Remarks/Conditions:_ Prepared by:

I/We hereby certify that all information contained in this application are correct and complete. I/We authorize you to obtain such information as you may require concerning the statements made in this application and that the sources to which you may apply for such information are hereby authorized to provide you the same. I agree that the application may remain your property whether the credit is granted or not Signature of Applicant Signature of Spouse or Co-maker

Rate:_

Term:_

Checked by:

Approved by:

Note : Only Application forms submitted with complete requireements will be received and processed. 1. Photocopy of 2 Valid ID (SSS/GSIS or TIN ID or Driver's or PRC License ID with Prsent Employee's ID 2. Photocopy of latest 2 months payslips or ITR. 3. Photocopy of latest Proof of billing ( Meralco, Maynilad, Telephone Bill Statement).