Professional Documents
Culture Documents
PERSONAL DATA
Name of Applicant:
Residence Address:
Educational Attainment:
Name of Spouse:
Occupation of Spouse:
Educational Attainment:
Number of Dependents:
Name
Age:
Length of stay:
Birthplace:
Age:
Birthplace:
Age
COURT CASES
Court/Location
School
Case No.
SAVINGS HISTORY
Name/Address of Institution
1.
2.
Total Savings
PROOF OF PAYMENT:
Bills
Water
Electricity
Grade/Year
Plaintiff
Date
Granted
Date Filed
Date
Due
Remarks
Remarks
Status
of Loan
Amount
Documents Supplied
Telephone
Installment Plan
Mortgage/Rental payments
Loan payments
Others
REAL PROPERTIES OWNED:
Description
Reg. No.
Area
Location
Improvements
TOTAL
Current Value
Remarks
TOTAL
MAIN BUSINESS ACTIVITY
Type of Business :
No. of years in the business:
Location of Business:
Type of shop or stall:
None/Temporary
At home/permanent
In or near the public
(check)
structure
structure
market, permanent
Business space:
Owned:
Rented:
If rented, have lease contract? (Y/N)
Type of Goods Produced/Merchandise/Services Provided:
INVENTORY OF BUSINESS ASSETS & MERCHANDISE INVENTORY
Type/Description
Quantity Unit Price Total Value
Business Assets / Supplies
Sub-Total
Stock for Resale
Sub-Total
Total
BALANCE SHEET
ASSETS
Cash on hand
Bank Deposits (Credit coop)
Accts. Receivable
Real Properties
TOTAL LIABILITIES
Personal Assets
Business Assets
TOTAL ASSETS
SALES:
Frequency of sales/income from business (daily, weekly or monthly):
Gross sales (daily/weekly/monthly)
High
% of credit sales to total sales:
BUSINESS TRENDS:
Peak Months :
Slow Months:
Daily
Low
Normal
Regular Months:
WORKING CAPITAL:
How often do you buy stocks/raw materials?
How much do you normally spend each time?
Where do you usually get your stocks?
Do you get your stocks on cash, credit or consignment basis?
CASH FLOW ANALYSIS (See attached sheet)
RESULTS OF INTERVIEW WITH CREDITORS/SUPPLIERS
Supplier/Creditor 1
Supplier/Creditor 2
I hereby certify that all the information stated in the Credit Analysis Report are true and correct and that I shall be held responsible for any
misrepresentation.
(Date)
(Account Officer)
Maria Anne
Pedro
COURT CASES
Court/Location
Barangay records
Municipal court
Birthplace:
School
10
8
Case No.
NONE
NONE
Birthplace:
10,000
Grade/Year
5
3
Plaintiff
N/A
Date
Granted
8/10/05
Date Filed
N/A
Date
Due
11/21/05
P100 daily
SAVINGS HISTORY
Name/Address of Institution
1. San Jose Credit Cooperative (share capital)
2.
Total Savings
PROOF OF PAYMENT:
Bills
Documents Supplied
Water
August, September, October 05 ORs (#
3389979, # 3378821, #3395468)
Electricity
August, September, October 05 ORs
(# 2456788, #2498027, # 2502267)
Telephone
Global mobile phone bill paid
Installment Plan
Mortgage/Rental payments
Receipt from Tax authorities
Loan payments
records of loan payments (Bombay)
Others
REAL PROPERTIES OWNED:
Description
Reg. No.
House
Area
1,250 ft
Location
104 Gonzaga St
San Jose, Panay
Age:
Length of stay:
San Jose, Panay
Age:
37
12 years
38
Iloilo City
Remarks
Applicants mother cares for
Children after school
Remarks
N/A
Status
of Loan
Fully paid
Amount
1,500
1,500
Comments (on time, delinquent payment,etc.)
On-time
On-time
On-time
On-time
On-time
Improvements
Renovated Clinic Room
Current Value
P200,000
TOTAL
P200,000
Remarks
Tax docs only
TV
Refrigerator
CD player (mini-component)
Tricycle
Dec-02
Mar-01
Dec-03
Nov-99
15,000
15,000
10,800
65000
TOTAL
5,000
7,000
7,500
32500
52000
0
0
0
13500
13,500
shelf
10800
10,800
Examination Table
Medical Tools
1
15
4320
1080
4,320
16,200
Stethoscope
Baby scale
Thermometers
1
1
2
3500
2700
400
3,500
2,700
800
bandages
110
880
sterile gloves
sterile needles
desk
chairs
50
25
1
2
15
165
15
20
12
20
6
10
15
14
50
25
750
4,125
2,700
3,240
71,515
3,150
3,600
1,800
4,000
420
2,050
2,250
2,520
250
6,250
26,290
97,805
2700
1620
Sub-Total
210
180
150
200
70
205
150
180
5
250
Sub-Total
Total
BALANCE SHEET
ASSETS
Cash on hand
500
Bank Deposits (Credit coop) 1,500
0
1,250
Accts. Receivable
2,500
Real Properties
200,000
TOTAL LIABILITIES
1,250
Personal Assets
52,000
350,355
Business Assets
95,105
TOTAL ASSETS
351,605
351,605
SALES:
Frequency of sales/income from business (daily, weekly or monthly):
Daily
Gross sales (daily/weekly/monthly)
High
P55,000
Low
P25,000
Normal
P40,000
% of credit sales to total sales:
5-10% (gives partial
On deliveries if family cant pay it all at once/)
credit
BUSINESS TRENDS:
Peak Months :
August Oct.
Slow Months:
April-May
Regular Months:
Rest of year
WORKING CAPITAL:
How often do you buy stocks/raw materials?
Monthly or as-needed
How much do you normally spend each time?
P15,000 - 18,000 per month
Where do you usually get your stocks?
Pharmaceutical distributor, retail pharmacy in town
Do you get your stocks on cash, credit or consignment basis?
Cash
CASH FLOW ANALYSIS (See attached sheet)
RESULTS OF INTERVIEW WITH CREDITORS/SUPPLIERS
Supplier/Creditor 1
JOSIE PATINA, Wyeth
Pharmaceuticals
10 years
No
Supplier/Creditor 2
REYMUNDO CARLOTTA, Mercury
Drugs, pharmacist and store
manager
Over 2 years
No
3 years
Yes
No, she always pays in cash
Yes
No, she pays in cash
11/25/05
11/25/05
December 1, 2007
(Date)
TERESA TENNARIO
(Account Officer)
10