LOAN APPLICATION FORM

VEHICLE INFORMATION

MAKE/MODEL: SRP: DOWNPAYMENT:

AMOUNT FINANCED: TERM: SALES EXECUTIVE:

TYPE OF VEHICLE: BRAND-NEW PERSONAL USE

USED BUSINESS USE
OTHERS (PLS. SPECIFY): REFINANCE

PERSONAL INFORMATION / BENEFICIARY OWNER INFORMATION

BORROWER'S NAME:
LAST FIRST MIDDLE
BIRTHDATE (MM/DD/YYYY): PLACE OF BIRTH: CITIZENSHIP: LANDLINE:
GENDER: MALE MARITAL STATUS: SINGLE WIDOW/ WIDOWER ANNULED ACR NO. (IF FOREIGNER) MOBILE:
FEMALE MARRIED SEPARATED E-MAIL ADDRESS:

PRESENT ADDRESS: YEARS IN PRESENT ADDRESS:

PERMANENT ADDRESS: YEARS IN PERMANENT ADDRESS:

PROVINCIAL ADDRESS: YEARS IN PROVINCIAL ADDRESS:

RESIDENTIAL STATUS: OWNED MORTGAGED OTHERS (PLS. SPECIFY): TIN NUMBER:

RENTED WITH FAMILY SSS/GSIS NUMBER:

WORK/BUSINESS INFORMATION
EMPLOYMENT STATUS: PRIVATE GOV'T OFW SELF-EMPLOYED LICENSED PROFESSIONAL RETIRED
LEGAL FORM SINGLE PROPRIETORSHIP CORPORATION PARTNERSHIP
PRESENT EMPLOYER/BUSINESS NAME: EMPLOYER INDUSTRY/BUSINESS TYPE:
CONTACT PERSON:

PRESENT EMPLOYER/BUSINESS/PLANT ADDRESS: LANDLINE:

FAX NUMBER:
COMPANY E-MAIL:
YEARS WITH PRESENT EMPLOYER:
POSITION/DEPARTMENT: IF SELF-EMPLOYED/CORPORATE YRS. OF OPERATING BUSINESS:
SPOUSE / CO-MAKER INFORMATION

CO-MAKER'S NAME:
LAST FIRST MIDDLE
BIRTHDATE (MM/DD/YYYY): PLACE OF BIRTH:
PRESENT ADDRESS: YEARS IN PRESENT ADDRESS: TIN NUMBER:
LANDLINE: MOBILE NUMBER: E-MAIL ADDRESS: SSS/GSIS NUMBER:
EMPLOYMENT STATUS: PRIVATE GOV'T OFW SELF-EMPLOYED LICENSED PROFESSIONAL RETIRED
LEGAL FORM: SELF PROPRIETORSHIP CORPORATION PARTNERSHIP
PRESENT EMPLOYER/BUSINESS NAME: EMPLOYER INDUSTRY/BUSINESS TYPE:
PRESENT EMPLOYER/BUSINESS ADDRESS: COMPANY E-MAIL:
YEARS WITH PRESENT EMPLOYER:
POSITION/DEPARTMENT: IF SELF-EMPLOYED, YRS. OF OPERATING BUSINESS:
CHILDREN'S INFORMATION
NAME AGE SCHOOL GRADE/LEVEL

FINANCIAL STANDING
MONTHLY INCOME MONTHLY EXPENSES
SOURCE OF INCOME BORROWER SPOUSE DESCRIPTION OF EXPENSES AMOUNT
SALARIES RENTAL EXPENSE
HOUSEHOLD EXPENSE
EDUCATION EXPENSE
LOAN AND CREDIT EXPENSE
OTHERS OTHERS (PLS. SPECIFY)
BANK AND FINANCIAL INSTITUION INFORMATION
NAME OF BANK/FINANCIER TYPE OF INTEREST CREDIT LINE BALANCE MATURITY SECURITY
BORROWING RATE %

VEHICLES OWNED
VEHICLE TYPE YEAR/MODEL BODY TYPE BANK (IF MORTGAGED)

NUMBER OF EMPLOYEES AND OTHER COMPANY INFORMATION

CATEGORY QUANTITY CORPORATE TIN NUMBER:
SUPERVISORS:
WORKERS: COMPANY SEC NUMBER:
BACK OFFICE STAFF:
MAJOR SUPPLIER (USE SEPARATE SHEETS IF NECESSARY)
NAME BUSINESS LINE PHONE NUMBER CONTACT PERSON/TITLE PURCHASED PRODUCT/% TRADE YR.

TOTAL NUMBER OF SUPPLIERS (%): DOMESTIC PURCHASE (%): IMPORT (%):

MAJOR CUSTOMER (USE SEPARATE SHEETS IF NECESSARY)
NAME BUSINESS LINE PHONE NUMBER CONTACT PERSON/TITLE PURCHASED PRODUCT/% TRADE YR.

TOTAL NUMBER OF BUYERS (%): DOMESTIC SALE (%): FOREIGN SALES (%):
 PERSONAL REFERENCES (USE SEPARATE SHEETS IF NECESSARY)
NAME PHONE NUMBER RELATIONSHIP ADDRESS

CERTIFICATION, CONSENT, AND WAIVER

• The Borrower hereby certifies that provided information are true and correct and shall form part of the loan documents and the signatures indicated herein are genuine. The Borrower’s or
his authorized representative’s provision of any information which is not true or updated may cause Chailease Berjaya Finance Corporation (CBFC) to reject the Borrower's loan application or
cancel its approval.
• The Borrower hereby with full knowledge of the right under the law, waives the right to confidentiality of information and authorizes CBFC to disclose, divulge and reveal any such
information relating to the borrower’s account, including but not limited to events of default, client evaluation, credit reporting or verification and recovery of the obligation due and payable
to CBFC, to third parties such as, but not limited to, Credit Information Corporation, Banker's Association of the Philippines - Credit Bureau (BAPCB), service providers, or to any similar entities.
• The Borrower holds CBFC free and harmless from any and all liabilities, claims and demands of whatever kind or nature in connection with or arising from the aforementioned disclosure or
reporting.
• The Borrower authorizes CBFC to obtain relevant information as it may require concerning this application from other institutions/persons. All information obtained by or provided to CBFC
pursuant to this application shall be CBFC's property whether or not the loan is granted.
• The Borrower hereby consents and authorizes CBFC to conduct random credit and property verification from the Land Transportat ion Authority, Land Registration Authority, Local Registry
of Deeds, Local Assessors Office, Local Treasurer’s Office, Mayor’s Office, Business, Permits and Licensing Office, Department of Trade and Industry, Bureau of Internal Revenue, and any other
appropriate government agencies or third parties, including private and public banks and financial institutions, to establish the authenticity of the information declared, to verify properties
under the name of the applicants and documents submitted, as may be necessary for the processing and evaluation of this application and for the recovery of any unpaid loan obligation as
the case may be.
• The Borrower further authorizes CBFC to furnish copies of any and all loan related and supporting documents submitted by or applied by the Borrower which includes but not limited to
Insurance Policies, Application Forms, Bank Statements, Proof of Billings, and other similar documents to CBFC's stakeholders such as car dealers, truck dealers, heavy equipment dealers, and
third party service providers, for legitimate business purposes.
• The foregoing shall continue to be in full force and effect until the borrower’s loan obligation with CBFC has been fully extinguished.

CLIENT CONSENT:

I hereby authorize CBFC, to process my foregoing personal information, sensitive or otherwise, for the purpose of accessing my credit report containing consolidated positive and negative credit
information in connection with my application for and availment of credit facilities from different financial institutions.The undersigned is/are the bona fide and true account holder(s) and authorized
signatory(ies) of the bank accounts listed below:

Bank Branch Account Number

Furthermore, I acknowledge that I have been informed of my rights under Republic Act No. 10173, otherwise known as the Data Privacy Act and further recognize that I have been duly informed of the
purpose, scope, source and method of the data processing involved including how long my personal information will be retained .

By executing this Certification, Consent, and Waiver, the undersigned hereby consents and waives his/her/their right of confidentiality under Philippine bank secrecy laws, including but not limited to
Republic Act No. 1405 ("Bank Secrecy Law"), Republic Act No. 6426 ("Foreign Currency Deposit Act of the Philippines"), Republic Act No. 8791 ("The General Banking Law of 2000"). This waiver is in favor
of Chailease Berjaya Finance Corporation (CBFC) and authorizes CBFC and its representatives to access the below specified ban k accounts.

The undersigned hereby authorizes the concerned banks to provide CBFC with all pertinent information regarding my/our account s, including but not limited to the following:

(1) date opened;

(2) average daily balance;
(3) signatories;
(4) current balance;
(5) history of dishonored checks;
(6) account handling; and
(7) other information as may be necessary for the evaluation and processing of my/our loan application with CBFC.

We appreciate your bank's assistance in this matter and request full cooperation in providing the necessary information to CB FC's representative(s).

This authorization and consent shall be valid and applicable for one (1) credit report pull only.

Executed this [Date] in [City/Municipality], Philippines.

Borrower's Full Name & Signature Spouse/Co-maker's Full Name & Signature

Mobile No. Mobile No.

Landline No. Landline No.
Email Address: Email Address:
CONSENT TO CHECK BANK & FINANCIAL INSTITUTIONS DEPOSIT / LOAN
To whom it may concern:
I/We hereby authorize Chailease Berjaya Finance Corporation and its representatives to conduct checking on Bank Account/s, Deposit, Loan Details mentioned below
in connection of my/ our Loan Application with the company:

Bank / Financial Institution Branch Account No. Type of Loan

I/ We appreciate the bank’s / financial institution's assistance in this matter and thank you in advance for your cooperation.

Sincerely,

(Signature Over Printed Name)