___________________Store

CO-
CO - MAKER’S
MAKER S STATEMENT

Name: ____________________________________ AGE: ________ NATIONALITY: ______________________

TO: EAST WEST RURAL BANK, INC.

_______________________Store

I agree to become a CO-MAKER with the applicant____________________________________ in signing the Promissory Note
which will evidence the loan applied for, if granted, for an amount not exceeding P____________________________, I am aware
of the responsibility of a promissory note co-maker which I will assume in signing the said note.

I authorize you to obtain such information as you may need concerning the information written and statements made
hereunder & I agree that the document shall remain your property whether or not the loan is granted.

PERSONAL INFORMATION
Home Address___________________________________________________________________________________________________________
No. of years in this Address: _________________________ No. of years in this community:_______________
Married to __________________________________________ No. of dependents:__________________________
Salary, Commission or other Regular Income per Month:

DESCRIPTION OF INCOME AMOUNT

_____________________________ P _______________________
_____________________________ _______________________

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EMPLOYMENT

Connected with : _____________________________________________________

Since When : _____________________________________________________
Name of School : _____________________________________________________
Your position : _____________________________________________________
How Long : _____________________________________________________
Name & Title of Supervisor : _____________________________________________________
Previous Employer : _____________________________________________________

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MISCELLANEOUS

How long have you known the applicant? _________________ Are you related? _________ How? ___________
Have you ever been a borrower?__________________ Name of lender:___________________________________
Have you ever been a co-maker? _________________ Borrower’s Name: ________________________________

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I hereby certify that all information given above are true and correct.

___________________________
Signature of Co-Maker

___________________________
East West Rural Bank, Inc. DATE
#360 Dr. Sixto Antonio Avenue, Brgy. Caniogan
Pasig City, 1606 Philippines
Telephone No. +632 916-1023, 643-6334
HELPDESK NO.: +63 9173116411, 9189930270, 9328578397