APPLICANT’S INFORMATION:

FULL NAME: Birth Date: Age:

________________________________ ________
______________________ _______________________ ____________________ ______
First Name Middle Name Family Name Suffix (Jr./Sr.)
BIRTH PLACE:
_________________________________________________
Sources of Income: Civil Status: Gender:
TIN NO. : _____________________________
Farming Married Male
SSS NO. : _____________________________
Brgy. Honorarium Single Female
GSIS No. : _____________________________ Business Separated
Salary Widow
CP No. : ____________________________
Others: ____________________

ADDRESS: Purok Barangay Municipality Province Postal Code

Present Address: ______________ _________________________ _______________________ ______________________ __________

Permanent Address ______________ _________________________ _______________________ ______________________ __________

Position in Barangay: Brgy. Captain Brgy. Kagawad Brgy. Treasurer Brgy. Secretary Brgy. Tanod

Brgy. Health Worker Day Care Worker Others ______________________________

Years in Service: _______________________ years

Quarterly Honorarium: Farmlands: Business:

Riceland Area: ______________ hectares Type of Business: _____________________________
Php ____________________ Cornland Area: ______________ hectares Location : _____________________________

Full Name of Spouse (Asawa) Age: _________________________________

Cellphone No: ________________________
_____________________ _______________________ ____________________ ______
First Name Middle Name Family Name Suffix (Jr./Sr.) Occupation : ________________________
NAME OF CHILDREN STILL DEPENDENT EDUCATIONAL ATTAINMENT AGE

MOTHER’S MAIDEN NAME : First Name: _______________________ Middle Name: _____________________ Family Name: _______________ Age: _______

FATHER NAME : First Name: _______________________ Middle Name: _____________________ Family Name: _______________ Age: _______
(Please write even if they living or deceased)

AMOUNT & PURPOSE OF THE LOAN APPLIED FOR:

Purpose of Loan: _____________________________________________ Amount of Loan: Php ____________________ Term: __________ Qtrs.

PERSONAL REFERENCES

Name Address Contact Numbers

1. _________________________________ __________________________________________________ ____________________________
2. _________________________________ __________________________________________________ ____________________________
3. _________________________________ __________________________________________________ ____________________________
I hereby warrant that all information hereto disclosed are, to the best of my knowledge, true and correct. I further authorize the RURAL
BANK of RIZAL (K-A), Inc. to validate such information/s and obtain additional data required in connection with this application for its full
satisfaction.
Furthermore, I hereby acknowledge and authorize: 1.) the regular submission and submission of my basic credit data (as defined under
Republic Act No. 9510 and its Implementing Rules and Regulations) to the Credit Information Corporation (CIC) as well as any updates or
corrections thereof; and 2) the sharing of my basic credit data with other lenders authorized by the CIC, and credit reporting agencies
duly accredited by the CIC.

_______________________________________________ __________________
APPLICANT’S SIGNATURE OVER PRINTED NAME Date Applied
 TO BE ACCOMPLISED BY BANK PERSONNEL ONLY

CREDIT DEALINGS AND CAPACITY TO PAY ANALYSIS

Quarterly honorarium suffices quarterly amortization of loan.

Client previous credit dealings in the bank are satisfactory.

Client does not have yet credit exposures in the bank.

Client previous honorarium loan was past due but already settled.

LOAN PROCESSING IN-CHARGE RECOMMENDATION

Recommended Loan Amount: Php ___________________________________

Computed Maximum Loan Entitlement: _______________________________

Frequency of Payment: ______________________________________________

Recommended Loan Term: ___________________________________________

Proposed Loan Amortization: _________________________________________

Loan Creation: New Loan Reloan

R
e

Recommending for Approval:

DIVINA B. GAMMOOT
Loan Processing In-Charge

LOAN APPROVAL

Approved for: Php _______________________________ for ___________ Qtrs.

NERISSA L. ORODIO
Manager