Brevitas Resilire Obligatus Credit & loans Corp.
Application Form 2X2 Latest Picture
I-PERSONAL INFORMATION
Client's Name: Nick Name:
Contact No.: B-date: Age: Birthplace:
Present Address: Contact. No:
Permanent Address: Years of Stay:
Name of Spouse: Contact No: Age:
House: Owned Rented Civil Status: Married Separated Widow Single Sex: Male Female
II-HOUSEHOLD COMPOSITION AND SOURCES OF INCOME
(Write down all income including salary, pension, remittances, sari-sari store, etc.)
Household members and Current Occupation/Economic Regular monthly School/Business/
Age Relationship Years in operation
dependents Activity income/sales Employment Address
III-EMPLOYMENT INFORMATION
(for applicant and spouse, if any)
Name of Company Address Contact No. No. of Years Position /title Monthly Net
Employed Income
IV-BUSINESS ACTIVITES
Main Business Yrs. In Business No. of paid employees Workplace Characteristic
Owned Rented Home-based Commercial Ambulant
Secondary Business Yrs. In Business No. of paid employees Workplace Characteristic
Owned Rented Home-based Commercial Ambulant
V-LOAN INFORMATION
What is the maximum installment you can easily pay? _______________ Amount Applied:___________________________
How frequent? Daily Weekly Bi-monthly Monthly Term: ______months Salary Schld. ________
VI-LOAN PURPOSE
(Check all applicable boxes)
Agriculture Microenterprise Housing Microfinance
Rice Banana Sari-sari Store Home improvement
Corn Coffee Carenderia Home Repair
Sugar cane Other:_________ Dressmaking/Tailoring Home Financing
Mango Food Processing Lot acquisition
Tricycle Other:________________
Other:
VII-CREDIT INFORMATION
(Including credit card information, if any)
Creditor/ Outstanding
Supplier/Landlord Loan Amount Balance Term Maturity date Installment/Frequency
P_________ Daily Weekly Monthly
P_________ Daily Weekly Monthly
VIII-SAVINGS INFORMATION
Name of Bank/Institution Type of accounts Date Started Approximate balance
Placements/Bonds Ordinary savings
Checking Account Time Deposits
IX-AFFILIATIONS/MEMBERSHIPS
Name or organization Position Date Started
X-CO-MAKERS INFORMATION
Name: Name:
Address: Address:
Birthdate: Birthdate:
Civil Status: Married Single Widow Separated Civil Status: Married Single Widow Separated
Cel. No.: Cel. No.:
XI-AUTHORIZATION
I confirm that the above information is true and correct to the best of my knowledge. I am aware that any false statement may be an immediate cause for
denial of this loan. In connection with this application, I authorize Brevitas Resilire Obligatus Credit & Loans Corp. to obtain such other information as may be
required. This authorization includes obtaining information from suppliers, commercial banks, rural banks, and all other creditors while releasing these
institutions from liability under any and all bank secrecy laws.
Signature of applicant :______________________________ Date/Place _________________________
Signature of Spouse :________________________________ Date/Place _________________________
XII-FOR ACCOUNT OFFICER'S USE ONLY
Client requirements ( Please check)
Name and signature of AO: ___________________________________________ Cedula
2x2 picture
Notes/Comments and Recommendations: Photocopy of Any Valid I.D. card
Proof of billing
Draw Sketch of Residence
cture