AUTO LOAN APPLICATION FORM

(FOR INDIVIDUAL)
*Failure to provide sufficient and accurate information in this Application Form may result to JACCS’s inappropriate determination of the financial requirements of the Borrower. (mm/dd/yyyy)
Borrower Type
For JACCS Use Only: Program/Promotion: Date:
Principal Co-Borrower

REFERRAL INFORMATION
REFERRAL INFORMATION
Unit / Branch Dealer Dealer's Sales Agent/Sales Executive

JACCS' Account Officer Others

BORROWER’S INFORMATION
BORROWER'S INFORMATION
*Name (First, Middle, Last) *Date of Birth (mm/dd/yyyy) *Place of Birth

*Gender Male *Civil Status Single Married Separated No. of Dependents *Citizenship Filipino
Female Annulled / Divorced Widow/er Foreigner, ACR No.
*TIN *SSS / GSIS No. *Mobile. No. Prepaid
Postpaid
*Residence Tel. No. (Area Code, Number) *Office Tel. No. (Area Code, Number) Fax No. (Area Code, Number) *Email Address

*Mother’s Maiden Name (First, Middle, Last) *Father’s Name (First, Middle, Last)

*Present Address (No. / Street / Barangay / Municipality or City / Province / Country) Zip Code Length of Stay (Year/s | Month/s)

Home Ownership Owned Rented Mortgaged Used free Living with Relatives

*Permanent Address (No. / Street / Barangay / Municipality or City / Province / Country) Zip Code Length of Stay (Year/s | Month/s)

Previous Address (No. / Street / Barangay / Municipality or City / Province / Country) Zip Code Length of Stay (Year/s | Month/s)

Are you related to a JACCS employee?

If Yes, indicate full name (First, Middle, Last) and relationship

SPOUSE’S INFORMATION
SPOUSE'S INFORMATION
*Name (First, Middle, Last) Date of Birth (mm/dd/yyyy) Place of Birth

Citizenship Filipino TIN SSS / GSIS No.

Foreigner, ACR No.
Office Tel. No. (Area Code, Number) Mobile No. Prepaid Email Address
Postpaid

LOAN INFORMATION
LOAN INFORMATION
Loan Purpose Use Vehicle Classification
Purchase Refinancing Personal Business Brand New Used

Kind of Vehicle Brand Type Model

Sedan AUV LCV SUV Trucks Others

Cash Price Down Payment Loan Amount Loan Term

EMPLOYMENT
EMPLOYMENT //BUSINESS
BUSINESSINFORMATION
INFORMATION
Borrower Spouse
Employed Self-Employed (Business) OFW / Immigrant Employed Self-Employed (Business) OFW / Immigrant
*Employment Type
Private Private
Self-Employed (Professional) Others Self-Employed (Professional) Others
Government Government

NGO NGO

*Business Type Single Proprietorship Partnership Corporation Single Proprietorship Partnership Corporation

*Employer / Business Name and Address (No. / Street / Barangay / Municipality or City / Province / Country
)

*Telephone / Fax No.

*Email Address

*Nature of Business

Years of Employment / Business

Position / Title
INCOME
INCOME DETAILS
DETAILS
Borrower Spouse
Gross Monthly
Income
 Other Monthly
Income
(Please specify)
Total Monthly Income

Combined Gross
Monthly Income
Rentals Loans and Credit Cards Other Expenses
Monthly Expenses
(*) Mandatory Field/s Version: Aug 2019

FINANCIAL INFORMATION / BANK RELATIONSHIP

Deposits Bank Branch Type of Account Account Number Date Opened (mm/yyyy) Outstanding Balance

Loans Bank Type of Loan Original Loan Amount Date Granted (mm/yyyy) Maturity Date (mm/yyyy) Monthly Payment

PERSONAL / TRADE REFERENCES

Personal references NOT living with you:
Contact Person / Position Relationship

Company Name / Address

Residence Tel. No. (Area Code, Number) Mobile No. Prepaid

Postpaid

Major Company Name Contact Person / Position Contact Number

Customers/
Suppliers

UNDERTAKING
1. The Borrower certifies the truthfulness of the information herein including the genuineness of his/her signature in this application. Giving of false information in relation to this application is a
sufficient cause for JACCS Finance Philippines Corporation (JFP) to reject the application or to cancel its approval.
2. The Borrower authorizes JFP to obtain relevant information concerning this application from other institutions/persons. All information obtained by or provided to JFP pursuant to this application
shall be JFP’s property whether or not the loan is granted.
3. The Borrower hereby waives confidentiality of client information including without limitation, the provisions of Republic Act Nos. 9510 (Credit Information System Act), 1405 (Secrecy of Bank
Deposit Act), 6426 (Foreign Currency Deposit Act), 10173 (Data Privacy Act of 2012), and Sec. 55.1b of Republic Act No. 8791 (General Banking Law)and any law relating to the secrecy of
bank deposits. The Borrower authorizes JFP to: (a) pursuant to BSP Circular no. 472 Series of 2005 as implemented by BIR Revenue Regulation RR-4 2005, conduct random verification with
the Bureau of Internal Revenue in order to establish authenticity of the ITR, accompanying financial statements and such other documents/information/data submitted by the Borrower, and/or
(b) obtain or disclose such information regarding the Borrower or the loan/credit facilities applied for hereunder to any party as JFP may deem necessary or as may be required or allowed by
applicable laws, rules and regulations.
4. In case of disapproval, the Borrower understands that JFP is under no obligation to disclose the reason/s for such disapproval.
5. The Borrower hereby agrees that JFP may allow its subsidiaries, affiliates and third parties selected by JFP to offer its products and services to the Borrower through mail, email, fax, SMS or
other means of communication. For this purpose, the Borrower further agrees that JFP may transfer and disclose selected Borrower’s information to its subsidiaries, affiliates and third parties
selected by JFP.
6. In compliance with the requirements of the Data Privacy Act (“DPA”), the Borrower authorizes JFP, its duly accredited service providers, business partners, subsidiaries and affiliates to process
his/her personal and/or sensitive personal information in relation to his/her loan application or credit transaction with JFP. These information may be collected, processed, stored, updated, or
disclosed by JFP or continually be collected, stored, processed and/or shared for five (5) years from the conclusion of the Borrower’s transaction with JFP or until the expiration of the retention
limits set by applicable law, whichever comes later, (i) for legitimate purposes, (ii) to implement transactions which the Borrower requests, allows, or authorizes, (iii) to offer and provide new or
related products and services of JFP, and (iv) to comply with JFP’s internal policies and its reporting obligations to Governmental Authorities under Applicable Laws.
The Borrower allows JFP, its duly accredited service providers, business partners, subsidiaries, and affiliates to process, collect, use, store, or disclose information (including without limitation,
the Borrower’s credit data in connection with any credit availment with JFP) to Government Authorities, to all credit information bureaus, including without limitation the Credit Information
Corporation defined in R.A. No. 9510, and to any third party (local or overseas) who acquires or will acquire the rights and obligations of JFP; who processes information, transactions, services,
or accounts, on behalf of JFP (including but not limited to courier agencies; telecommunication information technology companies; payment, payroll, collection, training, and storage agencies;
entities providing customer support, and other similar entities); or who requires the information for market research, product and business analysis, audit and administrative purposes, offering
of products and services, or for marketing or advertising activities undertaken by JFP.

Signature of Borrower Date Signature of Spouse/Co-Borrower/Co-Maker Date

over Printed Name over Printed Name