CREDIT APPLICATION FORM FOR MOTORCYCLE

LOAN
QD ID APP ID AOC CODE
Instructions: PLEASE PRINT LEGIBLY. Indicate NA in the fields which are NOT APPLICABLE
REFERRAL INFORMATION
NAME DEALER DEALER CODE DATE / TIME

PLEASE CHECK ONE Principal Borrower Co-Borrower LOAN PURPOSE LOAN Brand New LOAN AMOUNT
TYPE
(If co-borrower, please indicate name of your principal Second-Hand
borrower and relationship)
TERM (in months) DOWNPAYMENT

YES! I AM ENROLLING MY ACCOUNT TO THE POWER PERKS PROGRAM

Power Card Purchase and service discounts from Accredited Partners Power Connect Text information of accounts and promos Promo Rewards Referral promo on motorcycle loan 2X2 or passport size ID PICTURE with signature at the
PERSONAL DETAILS back
*NAME First Name Middle Name Last Name Nick Name

*GENDER Male *NATIONALITY if Non -Filipino ACR No. AGE *BIRTHDATE *TIN
(mm/dd/yyyy)
Female

MARITAL STATUS Single Widow/widowed for years Live-in *BIRTHPLACE *SSS / GSIS NO. NO. OF CHILDREN AND AGES

Married Legally separated for years

EDUCATIONAL MOTHERS FULL MAIDEN NAME (First Name, Middle Name, Last name) NO. OF DEPENDENTS
ATTAINMENT Elementary Grad College Undergrad (Other than children)

High School Grad College Grad

Vocational Postgrad / Doctorate

TYPE OF BORROWER

INDIVIDUAL ENGAGED IN BUSINESS NATURE OF BUSINESS

Workers in Formal Sector Single Proprietorship Agriculture, forestry and fishing Transportation and storage Education
Workers in Informal Sector Partnership Mining and quarrying Accomodation and food
Migrant Workers Corporate Manufacturing service activities Human health and social work
Pensioner Electricity, gas, steam and airconditioning supply Information and communication
Driver ASSET SIZE OF THE BUSINESS Water supply, sewage, waste management and Financial and insurance activities activities Arts, entertainment and
Farmer Up to P1.5M remidiation activities Real estate activities recreation
Fisherfolk More than P1.5M up to P15M Construction Professional, scientific and technical Other service activities
Recepient of Reminttance More than P15M up to P100M Wholesale and retail trade; repair of motor services Activities of private households as
More than P100M vehicles and motorcycles Administrative and support service
activities employers and undifferentiated goods
Public administrative and defense
compulsory social security and services and producing activities
of households for own use
Activities of extraterritorial
organizations and bodies
ADDRESS DETAILS
*PRESENT ADDRESS (Please check the box if this is your mailing address)
No. / Street Brgy. City / Municipality Province Zip Code

RESIDENCE OWNERSHIP HOME TEL NO. HOME FAX NO. LENGTH OF STAY
Owned Living with parents Company-provided border Years Months
Mortgaged Living with relatives Rented

Not Morgaged Bed Spacer / Border Others MOBILE PHONE Postpaid Prepaid E-MAIL ADDRESS

*PERMANENT / PROVINCIAL ADDRESS (Please check the box if this is your mailing address)
No. / Street Brgy. City / Municipality Zip Code

PREVIOUS ADDRESS (If less than 2 years in the present address)

No. / Street Brgy. City / Municipality Province Zip Code

EMPLOYMENT / BUSINESS DETAILS

NAME OF PRESENT EMPLOYER / BUSINESS NATURE OF BUSINESS NO. OF YEARS IN THE BUSINESS

EMPLOYER / BUSINESS ADDRESS IS YOUR BUSINESS REGISTERED?

Yes No

EMPLOYMENT STATUS EMAIL ADDRESS TEL. / FAX NO. LENGTH OF SERVICE

Regular / Permanent Pensioner Probationary Years Months
Contractual/ Project Hire / Consultant Recepient of Remittance Others (please specify) NATURE OF WORK RANK / POSITION / PERCENT (%) OF OWNERSHIP
Fixed Term Self- employed / Freelance
NAME OF PREVIOUS EMPLOYER TEL NO. LENGTH OF SERVICE

Years Months

PREVIOUS EMPLOYER ADDRESS RANK / POSITION IN PREVIOUS JOB

SPOUSE DETAILS
*NAME First Name Middle Name Last Name Nickname *MOBILE NO.

NATIONALITY If Non-Filipino, ACR No. AGE *BIRTHDATE *BIRTHPLACE

(mm/dd/yyyy)
ADDRESS *TELEPHONE NUMBER

MONTHLY INCOME DETAILS

*SOURCES OF FUND
Employment Remittance Others, please specify
Business Pension

+ + =
Salary Business Income Other Income Gross Income
EXISTING LOANS

BANK / FINANCIAL INSTITUTION TYPE OF LOAN LOAN AMOUNT MONTHLY INSTALLMENT TERM DATE GRANTED MATURITY DATE

PERSONAL REFERENCES (Other than living with the Borrower/Co-Borrower)

NAME COMPLETE ADDRESS (No./Street Subd./Brgy, Mun/City, Province) CONTACT DETAILS RELATIONSHIP