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
borrower and relationship)
Second-Hand 156,000
TERM (in months) DOWNPAYMENT
motor loan 24 45,000
YES! I AM ENROLLING MY ACCOUNT TO THE POWER PERKS PROGRAM
2X2 or passport size ID PICTURE with signature at the
Power Card Purchase and service discounts from Accredited Partners Power Connect Text information of accounts and promos Promo Rewards Referral promo on motorcycle loan back
PERSONAL DETAILS
*NAME First Name Middle Name Last Name Nick Name

*GENDER Male *NATIONALITY if Non -Filipino ACR No. AGE *BIRTHDATE *TIN
(mm/dd/yyyy)
Female Filipino 25 07/15/1993 417-074-394
MARITAL STATUS Single Widow/widowed for ______ years Live-in *BIRTHPLACE *SSS / GSIS NO. NO. OF CHILDREN AND AGES

Married Legally separated for ______years Manila 3454965696 na

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

Blk. 1 Lot 16 Cilantro St. Mahogany Place 3 Acacia Estates Brgy. Bamban Taguig
RESIDENCE OWNERSHIP HOME TEL NO. HOME FAX NO. LENGTH OF STAY
Owned Living with parents Company-provided border 3 6
______ Years ______Months
Mortgaged Living with relatives Rented
8665704
Not Morgaged Bed Spacer / Border Others MOBILE PHONE Postpaid Prepaid E-MAIL ADDRESS

09778374264 mjgorobat15@gmail.com
*PERMANENT / PROVINCIAL ADDRESS (Please check the box if this is your mailing address)
No. / Street Brgy. City / Municipality Zip Code

Blk. 1 Lot 16 Cilantro St. Mahogany Place 3 Acacia Estates Brgy. Bamban Taguig
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

Starboard Manpower Services Inc. Manpower Agency 16

EMPLOYER / BUSINESS ADDRESS IS YOUR BUSINESS REGISTERED?

3rd Flr. PTC Bldg. Argentina St. Cor. Dona Soledad Ave. BLS Brgy. Don Bosco Paranaque Yes No

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

Regular / Permanent Pensioner Probationary 2909996
starboard2002.com 3
______ 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 Manpower Vice President/ 1% ownership
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
30,000
____________________________ 0
__________________________ 10,000
____________________________ 40,000
_________________________
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

na

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

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

Keziah Ann Gorobat Blk. 1 Lot 16 Cilantro St. Mahogany Place 3 Acacia Estates Brgy. Bamban Taguig 09272938258 sister
Diana Medina San Andres bukid 09569521126 co worker