SALARY LOAN APPLICATION

FORM
X New Loan CODE: 339 Registry No.
Reloan Voucher No.
Multiple Loan Date:

Seventy Thousand
I hereby apply for a loan in the amount of PESOS_______________________________________________________________________________________
70,000
(P_________________________) Education Purposes
for ________________________________________________________purpose 36 months
for a term of _______________________________
months, which I promise to pay in accordance with the rules, regulations, terms and conditions of CITY SAVINGS BANK as stipulated in the Promissory Note of even date;
which I certify to have read and understood clearly.

CUSTOMER INFORMATION

PERSONAL INFORMATION:
FRANCISCO JR.
Name in Print _____________________________________________________________________
TRANCE 26
Age _______________ SINGLE
Civil Status _________________________
Surname First Name Middle Gender:  Male  Female
Present Address: 2176 ROAD 6 FABIE ESTATE STA. ANA MANILA Date of Birth: 02/13/1994 Birth Place: QUEZON CITY
Permanent Address: 2176 ROAD 6 FABIE ESTATE STA. ANA MANILA Nationality: FILIPINO Mobile #: 09569109596
Email Address: francisco.trance@deped.gov.ph Zip code: 1009 Res. Tel. No.: 0282473308
Nature of work: EDUCATION/ TEACHING TIN #: 451485820000 SSS/GSIS#: 20055101572 CTC#: 12039491
(If Married)Spouse Information:
Name of Spouse: ______________________________________________ Age _______________ Tel. No. _______________________________________________
Name of Employer: _____________________________________________ Position ____________ Monthly Income: _______________________________________

EMPLOYMENT INFORMATION:
Name of Employer/School: MANUEL A. ROXAS HIGH SCHOOL-MANILA Employment Status: REGULAR-PERMANENT Employee No: 5905110
Address of Employer/School: PRESIDENT QUIRINO AVE. PACO MANILA Ofc. Tel. No.: Mobile #:
Source of Funds: SALARY Monthly Income: 28,754 Station Code: 504
Position: TEACHER III Div. Code: 304 Reg. Code:
IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR SALARY LOAN AND ANY REFUNDABLES
THAT IS DUE TO ME, I HEREBY AUTHORIZE CITY SAVINGS BANK TO CREDIT THROUGH MY BANK: Unionbank CitySavings
GSIS – UNIONBANK UMID/ECARD OR CITYSAVINGS SAVINGS ACCOUNT (SA22).
FRANCISCO TRANCE, JR.
Account#: 1095 8348 9473
_______________________________
Signature over Printed Name of the
Borrower

PRIVATE INFORMATION PROVISIONS FOR LOAN APPLICATION

The loan applicant (“Borrower”) acknowledges and agrees that, in the course of his/her loan
application with City Savings Bank, Inc. (“CitySavings”), and throughout the term of his/her loan if
such loan application is granted, CitySavings may receive or have access to Personal Information
and/or Sensitive Personal Information and/or any financial information of the Borrower which
CitySavings may consider as relevant in evaluating the loan application; hereinafter collectively
referred to as “Private Information.” Borrower expressly consents to the processing, collection,
transmission, storage, disposal, use and disclosure of Private Information by CitySavings for the
following purposes:
(a) to manage Borrower’s account(s);
(b) to confirm, update and enhance CitySavings’s records;
(c) for statistical analysis;
(d) to establish any identity or otherwise as required under applicable legislation;
(e) to assess Borrower’s credit status on an on-going basis;
(f) for marketing and promotional of CitySavings products; or
(g) any other purpose, as considered necessary or appropriate by CitySavings.
In each case, the processing of Private Information may continue after the termination of the loan
agreement. CitySavings may disclose the Borrower’s Private Information:
(a) to a credit reference agency where it may be accessed by other financial institutions to
assist assessment of any application for credit made to CitySavings and for debt
tracing and fraud prevention;
(b) to its parent company or any of its affiliate or subsidiary;
(c) to any consultant, adviser, auditor, counsel, agent, contractor or sub-contractor of
CitySavings performing services for the purpose of assisting or rendering services to
CitySavings in the administration or promotion of its lending business;
(d) to any person to whom CitySavings proposes to assign or transfer any of its rights
and/or duties to the loan;
(e) to any guarantor or person providing security in relation to Borrower’s obligation;
(f) as required or permitted by law, regulation, court or any regulatory authority; or
(g) as otherwise considered necessary or appropriate by CitySavings.
“Personal Information” as used herein means information provided to CitySavings by or at the
direction of Borrower, or to which access was provided to CitySavings by or at the direction of
Borrower wherein: (i) the identity of an individual is apparent or can be reasonably and directly
ascertained; or (ii) when put together with other information, would directly identify an individual.
“Sensitive Personal Information” as used herein means any Personal Information that: (i) pertains
to an individual’s race, ethnic origin, marital status, age, color, and religious, philosophical or
political affiliations; (ii) pertains to an individual’s health, education, genetic or sexual life, or to any
proceedings in court; (iii) is issued by government agencies peculiar to an individual, e.g., social
security numbers and health records; or (iv) is specifically established by an executive order or an
act of Congress to be kept classified.
Furthermore by signing this form, the Borrower understands and expressly waives his/her right
under confidentiality laws including but not limited to RA 1405 or The Law on Secrecy of Bank
Deposits, RA 6426 or the Foreign Currency Deposit Act and RA 8791 of the General Banking Law
and their respective implementing rules and regulations and allow processing, storing, access to
sharing of any information regarding the aforementioned Salary Loan as well as the Bank products,
services and channels which the Depositor has activated, enrolled in or availed pursuant to this
Form.
CONFORME: FRANCISCO TRANCE, JR.
____________________________________________
Signature over Printed Name of the BORROWER

DO NOT WRITE BELOW THIS LINE - FOR CITYSAVINGS USE ONLY

RPSU AUTONOMOUS Newly hired with permanent appointment Complete required documents
NET PAY VALIDATION: (3 mos. Latest LOAN INFO: REDEMPTION:
REDEMPTION:
poriginal payslips) PLI
PLI Name:
Name: (Php)
(Php)
Branch Name: PLI
PLI Name:
Name: (Php)
(Php)
1. Month: (Php) Branch Sol ID: PLI Name: (Php)
2. Month: (Php) Scheme Code: SERVICING:
SERVICING:
3. Month: (Php) Group Code: Branch
Branch Name:
Name: Scheme
Scheme Code
Code

Application received and verified by: _____________________________________________ Date: __________________________________________

LOAN COMMITTEE:
Date Received ____________________________________
Remarks: ____________________________________________ AMOUNT APPROVED: __________________________________________
____________________________________________________ ____________________________________________ (P__________) only
____________________________________________________ TERM (in months) _________________________________
Name Date
We recommend a loan of P ________________________ ________________________ ___________________
be granted for a period of ________________________ / months ________________________ ___________________

Recommended by: ______________________________________ ________________________

 CO-MAKER’S STATEMENT / AUTHORIZATION FOR SALARY DEDUCTION
To the Treasurer/Disbursing Officer/Payroll Maker/ The Chief-IBM Division (RPSU Region)

FRANCISCO TRANCE JR.

We, the co-makers of ______________________________, hereby voluntarily and willingly, bind ourselves to pay jointly and severally all his/her unpaid obligations to City Savings Bank according to
the terms of the Continuing Suretyship below in case he/she fails to pay his/her obligations for any reason whatsoever, including the non-implementation or stoppage of his/her IBM salary
deductions. In case this happens we hereby authorize you to deduct from our salaries the amount of P___________ every month until the amount is paid in full.
(1)
Name in Print: JACIL LYNN VALDEZ FERNANDEZ Employee No./ID No.: Age: 25
Res. Address: 1537 FABIE STREET PACO MANILA Tel. No.: Mobile No.: 0915 492 0743
Designation: TEACHER I Date of Birth: 10/17/1994 Nature of Appointment: REGULAR-PERMANENT
Name of School: MANUEL A. ROXAS HIGH SCHOOL-MANILA Div. Code (DepEd Only): 304 Stn./Dist No. (DepEd only): 504
School / Office Address: PRESIDENT QUIRINO AVE. PACO MANILA

(2)
Name in Print: Employee No./ID No.: Age:
Res. Address: Tel. No.: Mobile No.:
Designation: Date of Birth: Nature of Appointment:
Name of School: Div. Code (DepEd Only): Stn./Dist No. (DepEd only):
School / Office Address:

We certify that the information we provided above and the borrower is true and correct.

JACIL LYNN VALDEZ FERNANDEZ

______________________________________________ ______________________________________________
Signature over Printed Name of the CO-MAKER Signature over Printed Name of the CO-MAKER

CONTINUING SURETYSHIP
CITY SAVINGS BANK, INC.
City Savings Bank Financial Plaza
Corner Osmeña Boulevard and P. Burgos St.,
Cebu City

Gentlemen:
FRANCISCO TRANCE JR.
For and in consideration of any indebtedness to you of ___________________________________________ (the “Borrower)” in the aggregate principal amount of
Seventy Thousand
________________ 70,000
(Php ________________ ) (hereinafter the “Loan”), under the terms and conditions of the Promissory Note(s) and other related documents duly executed by the
Borrower in your favor (hereinafter the “Loan Documents”), or any amendment or renewal thereof, the undersigned as primary obligors and not as mere guarantors, hereby warrant to
you, your successors and assigns, the due and punctual payment of any and all amount (including interest, penalties and other charges and expenses) due on the Loan.

This Suretyship extends to any renewal, restructuring, refinancing, amendment or extension of the aforementioned Borrower’s i ndebtedness.
In case of default by the Borrower to pay the whole or part of the Loan herein secured at maturity the undersigned agree and engage to you, your successors and
assigns, the prompt payment, upon prior written notice from you, of the obligations due and unpaid, including all interests, penalties and other charges and expenses that
have accrued or were incurred by you, your successors and assigns, in relation to the Loan.

The undersigned further warrant the due and faithful performance by the Borrower of all its obligations under the Loan Documents and any supplement,
amendment, change, or modification thereto.

The obligations of the undersigned hereunder are in addition to and not in substitution for any other security for the Borrower’s obligations as provided under the
Loan Documents and other related documents, and may be enforced without you first having to take recourse against any such security and without need of making any
demand on or taking any step or proceeding against the undersigned. For this purpose, the undersigned hereby unconditionally and irrevocably waives the benefit of
excussion as provided for under Article 2058 of the Civil Code of the Philippines.
Notice of acceptance of this Suretyship, and also of presentment, demand, protest and notice of dishonor of any and all such instruments, loans, advances,
credits, or other indebtedness or obligations herein before referred to are hereby expressly waived.

The liability of the undersigned is direct and immediate and not contingent upon the pursuit by you, your successors or assigns, of whatever remedies you or your
successors and assigns may have against the Borrower or the securities of liens you, your successors and assigns may possess, and the undersigned hereby agrees to
remain and be bound upon this Suretyship, irrespective of the existence, value or condition of any collateral, and notwithstanding also that all obligations of the Borrower to
you outstanding and unpaid at any time may exceed the aggregate principal sum herein above stated.

The undersigned agree that it shall not exercise any right of subrogation which it may acquire due to any payment or payments made hereunder until all sums
payable under the Loan Documents and other related documents shall have been paid in full.

The undersigned acknowledge that except by written agreement of the parties, no amendment, modification, or waiver of, or supplement to, any provision of the
Loan Documents shall operate to terminate or render ineffective this Suretyship.

The undersigned further agree that they shall have no right to assign this Suretyship including the Loan or any of their rights or obligations hereunder without your
prior written consent, and any such purported assignment shall be null and void and of no effect whatsoever.

In the event of judicial proceedings, the undersigned hereby expressly agree to pay you, your successors or assigns for and as attorney’s fees a sum equivalent to
twenty five percent (25%) of the total amount claimed, which in any case shall not be less than Ten Thousand Pesos (P10,000.00), exclusive of all cost of expenses for
collection allowed by law.

If any provision, term or condition of this Suretyship is held to be invalid or unenforceable, the same shall not adversely affect or impair the validity and
enforceability of the other provisions, terms and conditions hereof which shall continue to be in full force and effect.

Effective this _______________ day of _________

JACIL LYNN VALDEZ FERNANDEZ

______________________________________________ ______________________________________________
Signature over Printed Name of the CO-MAKER Signature over Printed Name of the CO-MAKER
CONFORME:

FRANCISCO TRANCE JR.

____________________________________________
Signature over Printed Name of the BORROWER

Pre-termination Clause
A 5% pre-termination fee shall be imposed based on the outstanding balance as of the date of full payment made before the end of term.

FRANCISCO TRANCE JR.

____________________________________________
Signature over Printed Name of the BORROWER

For complaints, you may do either of the following: approach the Consumer Protection and Assistance Officer of the day in the branch where you did the transaction, text hotline 0917-
8746753 or email to simpleisgood@citysavings.com.ph. Rest assured that we will address them the soonest possible time.

SIGNED IN THE PRESENCE OF (CITYSAVINGS USE ONLY)

____________________________________________ ____________________________________________
Signature over Printed Name Signature over Printed Name