ALL IN CONNECTIONS / BRAVO

LOAN APPLICATION FORM

Ref.#
Date
I. LOAN AMOUNT / PURPOSE / TERM
Amount of Loan: Purpose of Loan Term of Loan: Previous PNBSB Loan Date of Last Amort.
X New Borrower
To purchase various home 36 months
2,000,000.00 appliances and others Re-Availment N/A N/A
Loan Release Thru: X Manager's Check Credit PNB/PNBSB Account No.
Branch/Office where Acct. is maintained
II. PERSONAL DATA (Application and Spouse)
Applicant's Name: Family Name First Name Middle Name Date of Birth: Age: Sex:

KITO RODRIGO PALENG 9/20/66 52 MALE

Civil Status of Applicant: Single x Married Widow(er) Separated Citizenship: FILIPINO
Home Address: Telephone/Cellphone/Fax Numbers:
Megarealm Subdivision, Shontog, Shilan, La Trinidad, Benguet 0907-941-1299

Length of Stay at address above: Ownership: Own Car?

7 Months X Owned Living with Parents Others X Yes
5 Years Rented Free No

Employer: Upper Casecnan Hyrdro Inc.

Office Address: Megarealm Subdivision, Shontog, Shilan, La Trinidad, Benguet Telephone/Fax Numbers: 0919-7342-959

Nature of Business: Hydro Power Production Position: President & CEO Years with Firm 2 & 5 mon.

Name of Dependents Age: Name of Dependents: Age:

1. SHENAN BELLE C. KITO 16 3
2
4
Spouse : Family Name First Name Middle Name Date of Birth: Age
KITO ELIZABELLE COLAS 11/11/72 46

Spouse's Employer (or Business Name, if Self-Employed): Prime Castle Builders & Realty/Vegetable Trading
Office Address: Shontog, Shilan, La Trinidad, Benguet Telephone/Cellphone/Fax Numbers:
0928-193-7623/ 0908-1766-530

Nature of Business Built & Sell/Vegetable Trader and supplier Position: Proprietress Years with Firm: 5 yrs. / 15 yrs.
III. FINANCIAL DATA Annual Income Other Income Total Income Total Expenses Net Income
APPLICANT 3,070,000.00 172,500.00 3,242,500.00 2,973,692.00 268,808.00
SPOUSE 3,085,000.00 3,085,000.00 3,012,877.00 72,123.00
TOTAL 6,155,000.00 172,500.00 6,327,500.00 5,986,569.00 340,931.00
IV. CREDIT REFERENCES
TYPE BANK / COMPANY BRANCH CREDIT INFORMATION
Credit Card No.: N/A
Local Limit: Int'l Limit:
( Applicant is not a
credit card holder) Local Limit: Int'l Limit:
Loan / Credit Facilities:
Orig.Amt: Mo.Amort. Bal.
Orig.Amt: Mo.Amort. Bal.
V. CO-OBLIGOR
Co-Obligor's Name Family Name First Name Middle Name Date of Birth: Age: Sex:
Tangilag Judy Mae Penetrante 3/30/1994 24 Female
Civil Status of Co-Obligor: X Single Married Widow(er) Separated Citizenship:
Relation to Applicant: employee
Employer (or Name of Business, if Self-Employed): Upper Casecnan Hydro Inc.
Office Address: Megarealm Subdivision, Shontog, Shilan, La Trinidad, Benguet Tel/Cell/Fax Nos:
Nature of Business: Hydro Power Position: Accountant Years with Firm: 2 yrs.
VI. UNDERTAKING

I/we acknowledge that I/we have read and understood the requirements pertaining to this credit application and I/we promise that I/we shall abide by the same. I/we warrant
that all information provided herein are ture and correct to the best of my/our knowledge, and that same is being provided here for the purpose of obtaining credit from PNB
Savings Bank which I/we hereby authorize to obtain and verify such other information as may be required in connection with this application from references I/we have
provided or from any other source.

Signature of Borrower/Applicant Signature of Spouse Signature of Co-Obligor

TIN: 193-224-884 TIN: 287-081-112 TIN: 480-821-129-000
SSS/GSIS No.: CM-2037626 SSS/GSIS No.: SSS/GSIS No.: 0127523790
CTC No.: 17957204 CTC No.:17957205 CTC No.:
Place/Date Issued: 1/11/2019- La Trinidad, Benguet Place/Date Issued:1/11/2019- La Trinidad, Benguet Place/Date Issued: