Note: Please print legibly. If field not applicable, please write ‘N.A.’ Processing of application will start only upon submission of all required documents.
LOAN INFORMATION Desired Loan Amount: P Loan Purpose: Home Improvement
Tuition Fee/School Expenses
Credit Card Payment
PERSONAL INFORMATION Last Name Applicant: Status:
Middle Name Gender:
Separated Widowed Birthdate(mm/dd/yyyy): __/__/____
Male No. of Dependents: Birthplace: Length of Stay: Length of Stay: Length of Stay:
Present Home Address: Previous Home Address: Permanent Home Address: Mailing Address: Tel. No.: TIN:
Present Home Ownership:
Mortgaged Estimated Value: Educational Attainment:
College Highschool Type of Car/s Owned:
No. of Cars Owned:
Living with Relatives Bank:
Balance: Post Graduate
Vocational Make and Year:
Do you have any relatives working at PBCOM? Exisiting PBCOM Client?
Yes No If Yes, Name: If Yes, type of account:
Relationship: Account No.:
SPOUSE / CO-MAKER PERSONAL INFORMATION Last Name
Middle Name Male
If Co-Maker, relationship to borrower: Status:
Citizenship: Birthdate(mm/dd/yyyy): __/__/____ Present Home Address: Previous Home Address: Permanent Home Address: Tel. No.: Email: Mobile No.: TIN: GSIS No.: SSS No.: Exisiting PBCOM Client? Yes No If Yes, type of account:
No. of Dependents: Age:
Birthplace: Length of Stay: Length of Stay: Length of Stay:
SOURCE OF FUNDS Applicant Employed Private
Self Employed Retired
Government Employer/Business Name: Address: Occupation:
Nature of Work/Business: Tel. No.: Tenure: Previous Employer: Total No. of Years Working: Gross Monthly Income: Monthly Living Expense: Other Income Source: Investments Family Business
Spouse/Co-Maker Employed Private
Self Employed Retired
Government Employer/Business Name: Address: Occupation:
Nature of Work/Business: Tel. No.: Tenure: Previous Employer: Total No. of Years Working: Gross Monthly Income: Monthly Living Expense: Other Income Source: Investments Family Business
Personal Trade Supplier
Credit Card Company
CREDIT CARDS / BANKS / FINANCING INSTITUTIONS Card Number
DECLARATION I/We warrant that all information provided in this application form are true and correct. I/We agree that any material misrepresentation or falsity can be used by Philippine Bank of Communications (PBCOM) to pursue civil and/or criminal liabilities against me/us. I/We understand that PBCOM may, at its sole discretion, deny this application and further agree that PBCOM has no obligation to notify and furnish me/us the reason for such denial. Furthermore, I/we agree that all information obtained by PBCOM shall remain its property whether or not the application is granted. source, any credit reporting agency or any third party, for purpose of, among others, evaluating this application form, for credit reporting, and harmless from any liability that may arise from obtaining or disclosing such information.
stamp taxes, processing fees and such other fees as may be charged by PBCOM in connection with the loan shall be for my/our account.
Signature of Borrower over Printed Name Date:
Signature of Spouse/Co-Maker over Printed Name Date:
DISCLOSURE OF INTEREST RATES, FEES & CHARGES
* Interest rates and charges are subject to change without prior notice. All applications will be subject to the Bank’s credit policies and procedures.
INSURANCE (OPTIONAL) I would like more information on the Credit Life Insurance Product once my loan application has been approved. The Credit Life Insurance will cover the unpaid balance of the loan in the event of my untimely death. I further understand that the Credit Life Insurance Product is optional and has no bearing on the granting of the loan.
Signature of Borrower over Printed Name Date: