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Previous Home Address

Use black ink and complete all


fields.
Lot/Blk. House/Unit Floor No./Building Subd./Compound
If a field is not applicable, No. No. Name Name
please write ‘N.A.’
Fax to
Street City/Province Zip Code
_______________________________ Yrs./Months Yrs. Mos. Yrs./Months Yrs. Mos.
LOAN DETAILS at Present at Previous
Address Address
Desired Loan Amount Provincial Home Address
(Subject to Bank’s
approval)
Desired Loan Term
Lot/Blk. House/Unit Floor No./Building Subd./Compound
 12  18 months  24 months  36 months No. No. Name Name
months
Purpose of Loan
 Appliance  Education  Personal Street City/Province Zip Code
 Hospitalization  Balance Consumption Provincial Contact Number
Transfer Area Phone Phone
Code 1 2
PERSONAL INFORMATION Mobile Fax Email
Existing Loan   No
Customer? Yes
WORK AND FINANCES
Present Employment
Permanent? Part
First Name Middle Name Last Name  Yes  No  Yes  No
Owner?
Other Name Ttile Company   
 Mr.   Ms. ________________
(Alias) Type Private Governme Others
Mrs. __
nt
Se Date of Birth
 Male  Nature of
x (dd/mm/yyyy)
Female Business
Marital  Single  Married  Widowed  Position Rank
Status Separated
Employer/Business Name
Spouse Spouse
  No
Name Working?
Yes Employer’s Address
No. of Children No. of
Dependents
Lot/Blk. House/Unit Floor No./Building Subd./Compound
No. No. Name Name
Mother’s First Name Mother’s Middle Mother’s Last Name
Name
Philippine Nationali
 Yes  No Street City/Province Zip Code
Resident? ty
Office Contact Number
Educational  High  College  Others Area Phone Phone
Attainment School Graduate Code 1 2
 College  Post ___________ Mobile Fax Email
Level Graduate _
SSS No. TIN No. Previous Employment
Employer/Business Name
Residence Type

 Owned (Not Mortgaged) Previous Employer’s Address

 Owned (Mortgaged) Amortization/ P____________


Month
_ Lot/Blk. House/Unit Floor No./Building Subd./Compound
 Rented Rent/Month P____________ No. No. Name Name

 Used Free/Staying with


Relatives
Street City/Province Zip Code
 Others ____________________________________________ Office Contact Number
Current Home Address Area Phone Phone
Code 1 2

Lot/Blk. House/Unit Floor No./Building Subd./Compound


No. No. Name Name
Mobile Fax Email BASIC REQUIREMENTS
Yrs./Months at Yrs. Mos. Yrs./Months at Yrs. Mos.  Completely filled out application form
Present Previous
Company Company  Photocopy of latest ITR/form 2316
Monthly Income and Expenses (based on one month payslip)  Photocopy of ID issued by the employer with photo and
Basic Allowanc Deductio signature
e n
 Photocopy of one (1) month latest pay slip (original copy
SPOUSE DETAILS may be required prior to loan release)
Employer/Business Name  Other documents (may be required from the applicant to
process the loan)
Designation/Title/ Department
Rank All applicants with incomplete information and lacking
requirements will not be processed. Any alteration requires the
Office Contact Number
full signature of the applicant.
Area Phone Phone
Code 1 2 Upon approval, applicants will be required to issue post-
Mobile Fax Email dated checks for payment. Post-dated checks should be under
the name of the borrower.
OTHER DETAILS Handling Fee: P1,500.00 (automatically deducted
Bank References from loan proceeds)
Bank Name Branch Account Account Number NO FEE IS COLLECTED BY THE BANK OR ANY
Type REPRESENTATIVE
UPON APPLICATION.
___________________ ____________ ____________ ____________________
__ _ _ __ UNDERTAKINGS/AUTHORIZATION

I hereby certify that all information herein and in all supporting


___________________ ____________ ____________ ____________________ documents submitted with this application, are true and
__ _ _ __ correct. I hereby authorize the bank and/or its representative
to verify any and all information furnished by me including
previous credit transactions with other institutions. In this
___________________ ____________ ____________ ____________________
connection, I hereby waive any and all statutory and regulatory
__ _ _ __
provisions governing confidentiality of such information if
Credit Card Owned
Credit Card Issuer’s Name Member Card Card Limit
applicable. I fully understand that any misrepresentation or
No. Since Expiry failure to disclose information on my part as required in this
(mm/yyyy) (mm/yyyy application, may cause the disapproval of my application.
) Upon acceptance of my application, I legally bind to the
terms and conditions of Chinatrust including but not limited to
____________ ________________ ___________ __________ ___________ joint and several liability for all charges, fees, and obligations
_ _ _ _ incurred, and shall execute the necessary documents.
In case of disapproval of my loan application, I understand
____________ ________________ ___________ __________ ___________
that the bank is not obligated to disclose the reasons for such
_ _ _ _ disapproval.
Once I have received the loan proceeds, either via
Manager's Check, Cash, Electronic Fund Transfer or the Cash
____________ ________________ ___________ __________ ___________
Card, at the Bank's options, I am deemed to have fully
_ _ _ _
examined the Documents and have waived any and all
Personal Reference
Name Landline Mobile Number objections thereto.

A_______________________ _____________________ _____________________


_ __ __
__________________________ ___________
B_______________________ _____________________ _____________________ __ _
_ __ __ Applicant’s Printed Name and Signature Date

C_______________________ _____________________ _____________________ FOR BANK USE ONLY


Date Application

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