Business Express Loan

Application Form

Bank Information Owner Information

Existing Security Bank client? If YES, what type of relationship? Name (Last, First, Middle) Gender
Yes No Payroll Deposit/Investment Loans Male Female

Account number/s Relationship since Civil status No. of dependents

Single Married Separated Widowed Children ______ Others ______

Mother’s maiden name (First, Middle Last)

Date of birth (mm/dd/yyyy) Place of birth Citizenship TIN

Home address (Lot no./Block no./Street no./Subdivision/Barangay/City/Town/Province) ZIP code

Loan Details
Loan amount Loan term
12 mos. 18 mos. 24 mos. 36 mos.

Loan purpose
Working capital requirements Hiring new employees Duration of stay (in years) Home ownership
Owned (not mortgaged) Rented Others
Purchase of equipment/Fixed assets Marketing/Advertising Mortgaged Living with relatives ____________

Purchase/Remodel of workspace Refinancing/Take-out Email address Mobile no. Educational attainment

High school
Business expansion Others
(start new businesses/product lines) __________________________________ College
No. of cars owned Landline no.
Post graduate
Borrower Information Technical/Vocational

Type of borrower Sole proprietorship Partnership Corporation Credit card information

Business Information
Issuing bank Card number Credit limit
Business name/Company name Do you have a family business? TIN Do you have an
existing credit card?
Yes No
Yes
Years in business Number of employees Nature of business
No

Office address (Lot no./Block no./Street no./Subdivision/Barangay/City/Town/Province) ZIP code

Role in business

Position (latest on top) Duration of role (yyyy-yyyy) % of Business ownership

Plant address (Lot no./Block no./Street no./Subdivision/Barangay/City/Town/Province) ZIP code

Years in Years in
company industry

Telephone no./s Mobile no./s Email address

Spouse Information (if applicable)
Name (Last, First, Middle) Gender
Name (Last, First, Middle) Years in role Position % Ownership Male Female

No. of dependents Children __________________ Others ______________________

IF APPLICABLE

Mother’s maiden name (First, Middle, Last)

Date of birth (mm/dd/yyyy) Place of birth Citizenship TIN

Grant of Authority and Waiver of Confidentiality

1 . I/We hereby certify that all information herein are true and correct based on my/our own
Business Financial Information knowledge and further authorize SBC to obtain information as it may require concerning my/our
application to subscribe to this program and agree that it shall be retained by the Bank subject to
Latest year’s net income the bank's data retention policy, whether my/our application is approved or not. Any information
given by me/us or other persons I/we authorize, which is not true or accurate, will automatically
cause the Bank to reject my/our loan or cancel its approval.
Bank/deposit accounts 2 . I/We hereby willingly, voluntarily, and with full knowledge of my/our right under the law, waive the
right to confidentiality of information and authorize the Bank to disclose, divulge and reveal any such
Date opened Outstanding balance information relating to the account of the Borrower/Mortgagor, including events of default, for the
Bank Bank statement
(mm/dd/yyyy) (PHP) purpose of, among others, client evaluation and profiling, credit reporting or verification and recovery
of the obligation due and payable to the Bank under the Terms and Conditions of this agreement.

Yes No 3. In view of the foregoing, the Bank may disclose, divulge and reveal the aforementioned
information to third parties, including but not limited to my/our employer, the Bank's affiliates,
subsidiaries, agents or services providers, the Bankers' Association of the Philippines - Credit
Yes No Bureau (BSP - CB) or to any similar central monitoring entity or recipients as provided for by law
and required by competent authority.

Yes No 4. I/We further authorize the Bank, as my Attorney-in-Fact, to conduct random verification with the
Bureau of Internal Revenue (the "BIR") in order to establish the authenticity of my/our Tax
Statements (the "ITR") and the accompanying financial statements/documents submitted to the
Yes No Bank in accordance with banking regulatory requirements.
5 . I/We hold the Bank free and harmless from any and all liabilities, claims and demands of whatever
Yes No kind or nature in connection with or arising from the aforementioned disclosure or reporting.
6. I/We hereby acknowledge that the Loan or any part(s) thereof shall be deemed to have been
Loan/credit accounts availed on the date on which funds are transferred to my/our bank account maintained with the
Bank, or receipt of the Manager's Check reflecting the amount of the loan less applicable fees,
charges and taxes.
Bank Maturity date
Loan amount Monthly payment Loan type 7. I/We further authorize the Bank to deduct from my/our Loan proceeds all fees including, but not
(mm/dd/yyyy)
limited to, processing fees, documentary stamp tax, notarial fees and interest accruals, should the
first due date be over thirty (30) days from the release of my/our loan and other related charges.
8. I/We hereby agree that should my/our application be denied, the Bank has no obligation to furnish
the reason for such rejection or to return my/our application and other submitted documents.
9 . I/We further certify that the proceeds of the loan, if this application is approved, will be used solely
for the purpose stated in this application.
10. The foregoing shall continue to be in full force and effect until my/our loan obligation with the Bank
has been fully extinguished. This authority shall also cover subsequent renewals, extensions, increase
and availments and/or re-availments of my/our loan accommodation with the Bank.
11. I/We also legally bind myself/ourselves to the Terms and Conditions of the Promissory Note,
Disclosure Statement and other relevant documents that I/we shall execute in favor of the Bank.
12. I/We guarantee that I/we have obtained the consent of any or all persons named herein as
co-maker, guarantor, surety, past employer, supplier, seller of the property, or personal reference,
Business Trade References [List at least two (2) suppliers and two (2) customers] for all purposes necessary to this loan agreement. Any information given by me/us or other persons
I/we authorize, which is not true or accurate, will automatically cause the Bank to reject my/our
Major customers [Mandatory: at least two (2) customers] loan or cancel its approval.
13. I/We have read SBC’s privacy notice (www.securitybank.com/security-information) and understand
Annual sales that the Bank recognizes my/our rights as data subject under the Data Privacy Act of 2012. I/We
Company name Contact person Contact no. Credit terms
(PHP) hereby give consent to the processing of my/our personal data for purposes of obtaining the loan
and all other ancillary services necessary for the maintenance of my/our account/s and collection of
payment. Subject to remain in effect or five (5) years after account closure, I/we hereby give my/our
consent for SBC to share and process my/our information relating to my/our account/s to any
member of the SBC Group (SBC and its affiliates and subsidiaries reported as part of SBC’s
conglomerate map group structure as defined under BSP Circular 749) and Bancassurance
companies or their authorized Service Providers and representatives, for purposes of cross-selling
products and services, profiling and credit evaluation/reference checks, audit and account balance
confirmation and allow them to contact me/us for this purpose (i.e. by email, telephone, text, etc.) or
in case of audit where my/our account/s is/are chosen as sample for account balance confirmation.
No, I/we do not agree to have my/our account/s used for purpose of cross-selling products,
profiling and credit evaluation/reference checks, audit and account balance confirmation.

Major suppliers [Mandatory: at least two (2) suppliers]

Printed name and signature Date Printed name and signature Date
Annual of Applicant Borrower or of Applicant Borrower or
Company name Contact person Contact no. Credit terms Authorized Signatory Authorized Signatory
purchases
(PHP) Security Bank Corporation is regulated by the Bangko Sentral ng Pilipinas. For inquiries or complaints, you may contact
Security Bank at (+632) 8887-9188 or the BSP Financial Consumer Protection Department at (+632) 8708-7087.

For bank use only: Referral Information

Customer basic no. Sales ID

Branch/Unit Employee name

Credit Life Insurance Declarations

By signing and submitting this Application Form for Credit Life Insurance, I understand and expressly consent to the following:
Get fully protected with FWD’s Credit Life Insurance. Credit Life Insurance will repay your outstanding
1. The information and answers that I have provided in the Business Express Loan Application Form, this Application Form and any attached
Business Express Loan in the event of death.
document/s (collectively known as “Forms”) are complete and true. I acknowledge that FWD may nullify my Credit Life Insurance if I have
Application provided inaccurate or incomplete information or answers.
2. FWD may collect, use, and store the information provided in these Forms to process this application and to service my policies. The
I, _______________________________________________________
(Name of Client) (the “Insured Borrower”), am applying for Credit Life information gathered may be shared with FWD’s third parties and any medical information sharing facility, as may be necessary. These
Insurance provided by FWD based on the information that I have provided in Security Bank’s Business Express Loan information (including those which will be available during the life of my policies) may further be processed and shared for policy issuance
Application Form and this Application. and administration, claims adjudication, data analytics, historical and scientific research, profiling, risk management, enhancement of
products and services, identity verification, protection against fraud, and to comply with legal, regulatory, or contractual requirements. I
Health Statement Tick as appropriate acknowledge that in certain instances, my information may be processed through automated means.
1. I am in good health and have never suffered from, received advice or treatment for nor have any 3. I understand that FWD reports to its parent company located in Hong Kong and Singapore, and may engage third-party service providers
Yes No
indication of: cancer, cancerous growth/tumour, chest pain, heart attack, high blood pressure, and partners who, in some instances, may be located outside the Philippines. As necessary, my personal and policy information may be
stroke, diabetes, hepatitis, any disorder of the heart, lung, liver, kidney, spine, joints, digestive processed, shared, stored, and be subject to the laws of these foreign jurisdictions. FWD and its affiliates, third-party service providers and
partners, are required to protect the confidentiality of my personal information in a manner consistent with data protection principles.
system, mental or nervous disorder, blood disorder, endocrine disorder, disorder of eyes,
4. I authorize FWD to disclose my personal and financial information to FWD Group and any government or tax authority (within or outside the
alcoholism, drug abuse, AIDS or AID-related complications.
Philippines) for the purposes of ensuring FWD’s and FWD Group’s continual compliance with applicable laws, regulations, guidelines and
If you have answered “No”, please write the condition(s) that you have experienced: good market practices.
__________________________________________________________________________________ 5. FWD may contact me to request or clarify information to process this application, send me policy information, and perform other relevant
2. Within the past five years, I have not been admitted nor been advised to be admitted as an activities to service my policies.
Yes No
6. I attest that the consent of the Beneficiary/ies and all other data subjects in this Application form were obtained by me for the processing of
in-patient in a hospital or clinic except for a routine health checkup, cold, influenza, hepatitis A,
their information for purposes listed above.
upper or lower respiratory tract infections, gall bladder/kidney stones, tonsillectomy, herniotomy,
gastroenteritis, appendectomy, cholecystectomy, haemorrhoidectomy and pregnancy/birth. Privacy Policy: Your privacy is a priority for FWD. The Company keeps your personal information about you and the products and services you
If you have answered “No”, please write the condition(s) that you have experienced: have with us in confidence. For more information about our Privacy Policy, kindly visit our website at www.fwd.com.ph/en/privacy-policy. You
may also email our Data Protection Office at dataprotection.ph@fwd.com for any privacy concerns related to your information provided to us.
__________________________________________________________________________________
I expressly consent to the foregoing Data Privacy Declaration and understand that my failure or refusal to give consent may result to the denial
3. I have never had an insurance application or insurance policy declined, rated up, postponed, Yes No of, or inaction of this Credit Life Insurance application.
accepted on special terms or rescinded due to misrepresentation and/or concealment.
Please note: FWD will make every attempt to approve your application. If you ticked “no” to any (please tick box) Yes No
of the above questions, FWD may contact you to request further information about your health.
Beneficiaries Acknowledgement and Authorization
Upon your death while coverage is in force, FWD will repay your outstanding Business Express Loan Balance as at
I acknowledge and expressly authorize the following:
the date of death. Any death benefit remaining after this repayment will be paid to your below nominated Primary
Beneficiary and Contingent Beneficiary (if the Primary Beneficiary is deceased). 1. My insurance coverage will be in accordance with the terms and conditions of the
Credit Life Insurance Policy entered into by Security Bank with FWD.
Revocable Name (First, Middle, Last) Date of birth (mm/dd/yyyy) Relationship to you 2. To ensure continuous insurance protection, I authorize Security Bank to automatically
beneficiary Printed name and signature of
debit my account to cover for the Credit Life premium, if and when due.
the Insured Borrower
Primary 3. If death occurs within the first year of coverage and is the result of suicide whilst sane,
my insurance will be nullified and FWD will refund any premiums paid to my estate.
4.This Application is subject to the laws, regulations, and guidelines on Anti-Money
Contingent Laundering (AML) and Terrorism-Financing Prevention (TFP). Date of signing

FWD Life Insurance Corporation About FWD: In partnership with Security Bank Corporation, FWD is focused on creating fresh customer experiences, with easy-to-understand products, supported by
19/F W Fifth Avenue Bldg., 5th Avenue cor.32nd Street,Bonifacio Global City, Taguig City 1634 Philippines leading digital technologies. Through this customer-led approach, FWD will achieve its vision to become the leading Pan-Asian insurer that changes the way people
T: (+632) 8888-8393 | F: (+632) 8558-7393 feel about insurance. For more information, please visit www.fwd.com.ph