C i t i Personal Loan Application Form

Source Code .- Agentcode

Please Dqadvired that Citibanh Savings will rend you nlormatton regarding your application an4 your

/ a t t a c h t h e foioviinq requirements:
(If employed1 . L a t e s t incomeTax Return (iTR)/WZ
.Latest 1 month's payslip
.Two valid photo bearinq government issued IDS:
One Primary ID (current driver's license. SSS. TIN
o r valid passport)

.Last 2 months credit c a r d statement of account

(If self-employed) Additional financial statements w i t h bank stamp
L a s t 2 months bankstatements

8 evi-to- an CUI orneri w no persona aan w I i an avlnqs

: Fiipino or nan-Filipino reildent foreigners
: Phiiippine residents only

Addreri Requirement : Metro Manila, Metro Cebu, Metro Davaoand all iacationr
where Ciiibanh Savinqr Loan Centers are present
Telephone Availability : Must have a reridenceandlar burinerr phone

JAppanrelium#!ure JTraiii J C a r Pvrihasel Repar

3 i u t o n Fee Paywent 3 KeC8caiExpenrer J Debt Canial8dation

U Loan amount applied far 1 Maximum Loan amount allowed 3 Willing l o submit

My preferred manner of release of loan proceeds ir via:

3 Credit to my Bank Account number: p~

1 8 0 0 Cash Dirburrai:
3 Deliver Manager's Check
IautharizeCitibank Savings todeliver my msnager'schech to the biilinqaddrerl9perified
in Box It39 if i am not able to pirh-up my rhech within 48 hours from date01 approval.

Customer's Signature

Middie . . . . .~-

a" riqninq on this application form, i authorizecitibanksavings todoa credit the? mall my credit
cards and urt data available during the evaluation of my citi Persona! Loanapp1,tat~on.

CONTACT NUMBERS ● 910-5270 TO 75

TELEFAX ● 910-5271
 37 (Only for Self-employed)Your Personal Reference: You must haveat least2 trade rcferences
and 1 reference who is an accountant.
Please do not enclose payment. If your application ir approved, the documentary stamp tax and
RELATIONSHIP NAME ADDRESS PHONE NO. Drocessinq fee will be deducted horn the approved loan amount.
Relative
I Pro~eslinqFee / 4%0f Loan Am0~ntorP2.500whichever is applicable I
Friend I DocumentaryStamp P1.00lor every P2OO Approved Loan Amount or fraction thereof 1
Co-Employee Interest lntererton theCiti PersonalLoanshailbeinaccordance with the Promissory
Note and Oisclorure Statement governing thir Cfti Personal Loan
Only lor
Self.Employed: 1 Late Payment Fee 8% of amount due per month or P500 per month whichever ir hiqher 1
Trade
References 1 Bounced Check Fee P1.000.00 I
By siqnlnq below:
Total Arrets P
i hereby apply for a Citi Personal Loan. I warrant and aqree that all copies of
documents enclosed are true and remain the property of Citibank Savings (CSI).
IMPORTANT SECTION : Please fill o u t t o compiete t h e f o r m I warrant that ail information given in this Application Form are true and correct and

I As stated in the Banqko Sentral nq Pilipinas [BSPI Circular 622, you are required to
submit a coovol "our latest Income Tax Return (ITR). if aoolicable, dulv stamoed as
rete ,ed 5 i ' . i e ~ l , e a c a ' nrerna ne.en:e 0 R . r re pi i r xnerr r i 013. cDc n,
a* ar00:ler reg. sons i ,o. aree>qdqe? n P _ I ?PSI , o r i r e req. rro 13 ,.o" !
a (OF, ~1jc.r alest ' r m c d ~ldleme,.~ s . ~ ) ~ * l l ~ o l lodr ~ donl P.IPOIPO
I' !P=
8'7
if youare relf.employed, you MUST attest:
O I certify that I am the owner of a business, wherein its total arretr less thevalue
of the land on which my burlnerr'dfice, plant and equipment are situated is
[please check onel:
O up to P3 miilion
3 more than P3 million.up to P15 million
';I greater than PI5 million
If you receive purely compensation income fmm a single employer durinq the calendar
year, you MUST attest:
O I certify that I am qualified under the rubrtituted filing of ITR; that SIR Form
1604CFflled by my empioyer rhall constituteas my 1TR;andthat W2 rhall serve
ar a substitute for my ITR.
if you are not deriving salary, compensation or income from any burinerr, trade.
pmfe~sionor other activities, you must attest:
authorize CS1 t o investiaate the information from whatever sources CSI mav consider
appropriate. I authorize CSI t o obtain and disclose information about me from and
t o any affiliate of CSI, any reference source, any credit reportinq agency or any
subsidiary, or third party, for purpose of evaluatinq this application form, for credit
reportinq, verification, and other risk manaqement requirements. I authorize CSI t o
conduct random verification with the BIR in order t o establish the authenticity of my
iatest Income Tax Return (ITR) and other accompanying financial statements submitted
by me t o CSI. i aqree that this constitutes my written consent for any transfer and
disclosure of information relating t o my application for Citi Personal Loan. I confirm
and acknowledae that I shall hold CSI free and harmless from anv liabilitv that mav
arise from obtaining, transfer, disclosure or storaqe of such information relatinq t o
my application. i understand that CSI may, at its sole discretion, deny m y loan
application with no obligation on its part to advise me of such denial or furnish the
reason thereof. I aqree that the final termsandconditionsof any loan to be qranted
by CSI shall be aqreed upon after credit investiqation and approval of this application.
Upon such approval. CSi shall require me t o submit such other documents as may be
requiredfor the qmntinq of a loan, includinq but not limited to,copies of my certificate
of employment, valid identification cards, income tax returns duly stamped as received
by the BIR, amonq others. i aqree that i f approved, the documentary stamp tax,
processinqfee and such other fees as may be charged by CSI in connection with the
loan shall be for my account.
I aqree that mailinq of the manaqer's check, statements of account and other

I
O I certify that I am not dcrivlnq salary. compensationor income fmm any business,
trade, proferrion or other activities which require me under Philippine tar
lawrlrequlation to file any ITR, or be subject to the issuance of any certificate
of compensation paymentltax withheld ar a rubrtitvle to such ITR.
Customer'$ Signature
notices shall be t o the address soecified bv me in Box# 39 unless CSI encounters
difficulties in the deliveries t o the specified address.
iaqree that by receipt of the proceeds of my Citi Personal Loan either throuqh the
receipt, encashment or deposit o t t h e manaqer's check or by electronic transfer of
funds or any other specific means and failure t o return such proceeds to CSi within
one (1) bankinq day from such receipt, I confirm that I received the correct amount
correspondinq to the proceeds of my Citi Personal Loan.
i aqree that if the manaqer's check is for delivery, receipt of the manaqer's check
by my authorized representative at my Citi Personal Loan billinq address, who presents
. bv. mvself
an authorization letter sioned . and oresents a valid ID, shail be deemed t o

I NOTE. We will ppmcess your application only if you submit the complete set of required
documents.
.. ..
my *atemen's of arcodnlr aro a otter r0mm.n ca: on n C:lned on n .'I r,
be receipt by me of the manaqer's check personally.
i aqree that any electronic transfer of funds shall be subject t o the rules and
regulations of the receiving bank specified by me.
In the event of future delinauencv. .. I herebv authorize CSI t o reoort and/or include
C I Perms .~an to my 3 ng aao'err ,

my name in the neqative listinq of any credit bureau or institution.

Products and Services

On arcar on. C I o a n l SaPnyr ICS ma, worm mp aoa.! :r 2rOmo. cna o'ferr
I
1110~on m? @.ma fax ShlS 0' ovl* P P ~ O ~CS P ma, a roa 3 h Is sf' ales raenrr
an0 I C D I P S ~ ~ ! ~ .!P I B ~ O ' - r l 3,r' $5 ,SC:(PC 3 , 0 ' , t i I' em.-3 e r i a n :onlane%
to off& specially selected products and service; to he through m a i i l e - m a i l l f a ~ l ~ ~ ~
or bv telephone. For thir Puroore. CS1 mav transfer and disclose selected curtamer 1' Siqnature of Applicant over Printed Name Date Siqned

for thh purposes indicated above and undei apbllcabie laws and requldtionr Signature of Sllouse Date Siqned

8 Date Received:

Avail of Loan Protect Plus and give yourself
and your loved ones peace of mind.
Get maximum protection by insurinq your Citi Personal Loan up t o 5 times
its amount.
in case of death or permanent disablement, your family and loved ones
will receive a sum of monev that can be used t o cover health-related costs.
mortqaqe payments. t~ tlon or oiher expenses t o cover the r var1o.s neeas
P IS, yoJr lam y need no! wor- aoout ,o.r oan s nce Loan Prolecl Plus w
.pay. for theoutstandins balance on the .principal
. amount
For a minimal one-time upfront premium, your family's future is secure if
and when somethinq happens to you. The single premium includes all applicable
taxes.
Sample Singe Premium"costs per Loan Amount at 24 months
Secure your family's future. Enroll in Loan Protect Plus
and insure your Citi Personal Loan
up to 5 times its amount.
a I want t o be covered under Loan Protect Plus that will pay for the total
outstanding principal balance of my loan in case of death or permanent disablement.
Any amount of benefit in excess of the total outstandinq principal balance shall
be paid t o the insured in case of permanent disablement, or t o the beneficiarylies
in accordance with the Certificate of Coveraqe in caseof death.
i declare that I am between age 21 t o 58 years old, in qood health and have
not been hospitalized nor treated for any illnessin the past 12 months. I understand
that no benefit for death or permanent disablement wili be payable where the
event qivinq rise t o a claim is caused by an illness which occurred 12 months prior
to the effective date of my insurance. I agree t o be bound by all other terms and
conditions of the Certificate of Coveraue t o be issued by Pru Life insurance
Corporation of UK (Pru Life UK).

I authorize Citibank Savinqs (CSII to deduct the premium charqes from the
laan oroceeds for remittance to Citlcoro Financial Services and Insurance Brokeraae
Phils., Inc. (CFSI).

I authorize CSI and CFSI to provide any relevant information on me/ or my

loan account with CSI t o Pru Life UK for purposes of Loan Protect Plus.
**Final insurance premium depends on your aqe bracket and loan amount.

0:When does my Loan Protect Pius coverage start and what will the duration of
the coverage be? Loan Protect Plus Coveraqe

A: Your Loan Protect Pus coveraue starts on the day that vour loan is approved. 5 x loan amount Zx loan amount
I I I . I z, o e s e r l r ,q.r o nqaoorca 3t'er 3.2 i i i . 5
' c I . r . 7 . , co :?,ereo 1nro.qno.l rneen: -2c.r.: ..I?: 4 x loan amount equal to loan amount
vour loan. Your Loan Protect Plus coveraoe will terminate when vou refinance 3x loan amount
your ioan. However, the unearned premiums wili be appiied to the new account
and wiil reflect as payment to the loan.
O: How do i pay for the insurance premiums?
A: Your insurance premium wiil beautomatically deducted from your loan
proceeds. This is a one-time uplront payment.
O: Will I qet a refund if I decide t o pre-termnate my ioan? Siqnature el Applicant Over Printed Name Date Signed

A: Yes. The unearned premium will be arefunded t o you. However, the amount
will be minimal because it will be based on the Pre-Termination schedule
defined by the Insurance Company. IMPORTANT

Your premium refund will be appiied to the principal loan outstanding balance
a t t h e t i m e v o u pre-terminatevour oan.To ensure t h a t vour refund is
properly applied, you must advise your Relationship ~ a n a g e prior r to
pie-terminating the account. of Coveraqe,

C i t i never sleeps

Loan Protect Plus ir optional

csbank savings