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MOTORCYCLE LOAN APPLICATION

Date

Application N0.

Type of loan * IndividualInstitutional

Repeat Borrower * YesNo

Purpose of Availing Motorcycle Unit * Business - Self-employedTODA - Operator/DriverService - Commuting employeesOthers

product to be availed of: *

unit model *

selling price *

down payment *

term *

source of lead *

name of agent *

personal information: *

Last Name *

First Name *

Middle name *

Suffix

Civil status * SingleMarriedSeparatedWidow

Educational attainment *

citizenship *

nationality *

birthday *

birthplace *

present address *

permanent address *

TIN NO. *

SSS/gsis no. *

driver's license no. *

Email *

cellphone no. *

telephone no. *

Residence *

present address * yesno

Permanent address * yesno

Type of house *

Location *

House is made of *

family members/information: *

Family Member name *

Age *

gender * MaleFemale

relationship *

school/occupation *

PERSONAL / CHARACTER REFERENCES: *

Home *

name *

address *

contact no *

relationship *

barangay *

name *

address *

contact no *

relationship *

place of work *

name *

address *

contact no *

relationship *

FINANCIAL INFORMATION: *

Determination of Borrower's Ability to Pay *

work category *

Particular's *

employer *

contact person *

contact number *

Date Hired *

Nature of work *

status *

Employment Address *

Particular's *

contact person *

contact number *

Nature of work *

status *

Business Address *

SOURCE OF FUNDS *

Borrower *

Spouse *

Total *

Business *

Total *

Pension *

Total *

Salary *

Total *

Deposit/ Investment *

Total *

Regular Remittances *

Total *

TODA/Pasada *

Total *

Others *

Total *

Total Source of Funds *

Total: *

FAMILY EXPENDITURE *

Food *

House Rent *

Electricity *

Water *

Transportation *

Education *

Others *

TOTAL: *

Total Income: *

Total Net Income: *

Total Expenses: *

AUTHORIZATION TO CONDUCT CREDIT INVESTIGATION *

I hereby authorize Suerte Motoplaza to gather information from various sources about me and conduct verification on the foregoing personal information I have declared.

This authorization is given in support of my desire to apply and avail of a loan from said company for the acquisition of motorcycle unit from Suerte Motoplaza and/or its affiliates.

Important Reminder : The Customer Information Sheet (CIS) must be duly signed by the Client and by the representative of the Dealer and of the Bank who interviewed the client. Any misrepresentation of the information shall be possible ground for the disapproval of this loan application.

Suerte Motoplaza

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