DISCLOSURE STATEMENT OF LOAN AND CREDIT TRANSACTION

NAME OF BORROWER:_____________________ AMOUNT OF LOAN:_____________________

ADDRESS:________________________________ LESS ADVANCE INTEREST/PAYMENT:_____________
CONTACT NUMBER:________________________ NET LOAN:_____________________________

NAME OF CO-MAKER:______________________ REMARKS:

ADDRESS:________________________________
CONTACT NUMBER:________________________

DATE OF LOAD RELEASED:__________________

RATE:_______________
TERMS:______________
MATURITY DATE:_______________________
NEXT PAYMENT:_____________________

I AKNOWLEDGE THE RECEIPT OF A COPY OF THIS STATEMENT PRIOR TO THE CONSIGNATION OF CREFIT TRANSACTION AND THAT I UNDERSTAND AND
FULLY AGREE TO THE TERMS AND CONDITION HEREOF:

DATE:_____________
SIGNATURE OF OWNER:

SIGNATURE OF BORROWER: ________________ _______________________________________

ABEL S. FRANCISCO

SIGNATURE OF CO-MAKER:__________________

DISCLOSURE STATEMENT OF LOAN AND CREDIT TRANSACTION

NAME OF BORROWER:_____________________ AMOUNT OF LOAN:_____________________

ADDRESS:________________________________ LESS ADVANCE INTEREST/PAYMENT:_____________
CONTACT NUMBER:________________________ NET LOAN:_____________________________

NAME OF CO-MAKER:______________________ REMARKS:

ADDRESS:________________________________
CONTACT NUMBER:________________________

DATE OF LOAD RELEASED:__________________

RATE:_______________
TERMS:______________
MATURITY DATE:_______________________
NEXT PAYMENT:_____________________

I AKNOWLEDGE THE RECEIPT OF A COPY OF THIS STATEMENT PRIOR TO THE CONSIGNATION OF CREFIT TRANSACTION AND THAT I UNDERSTAND AND
FULLY AGREE TO THE TERMS AND CONDITION HEREOF:

DATE:_____________

SIGNATURE OF OWNER:

SIGNATURE OF BORROWER: ________________ _______________________________________

ABEL S. FRANCISCO

SIGNATURE OF CO-MAKER:__________________