• APPLICANT

    Personal Information
  • Title

  • Gender*
  • Marital Status*
  • Format: (000) 000-0000.
  • Applicant's Source of Income
  • *
  • Format: 0000-000-0000.
  • CO-MAKER / SPOUSE

    Personal Information
  • Title

  • Gender*
  • Marital Status*
  • Format: (000)-000-0000.
  • Co-maker's Source of Income
  • *
  • Format: (000) 000-0000.
  • Mitsubishi Pili CamSur Auto Loan Application

    After you fill out this application form, we will contact you to go over details for confirmation. If you have queries and questions you may contact Mavic Filio SALES ACCOUNT EXECUTIVE 0919-007-1620 mavicfilio02@gmail.comAUTHORIZATION AND AGREEMENT:I/We certify and declare that the information provided in this application form are true, correct and accurate.I/We acknowledge and agree that all information about me/us (including personal data of individuals related to me/us) as well as supporting documents which I/we have provided, made available to or in the possession of the Dealer may be collected, used, processed, disclosed and shared by said Dealer to partner banking institutions, their directors, officers, employees, representatives, agents and service providers to facilitate the processing, administration and approval of my/our loan application.I/We represent and warrant that, prior to submitting information including personal data of individuals related to us, we have obtained their respective authorizations and consent in accordance with applicable confidentiality and data privacy laws to enable the Dealer and partner banking institutions to process, administer and/or approve my/our loan application.The foregoing constitutes my/our express consent under the applicable confidentiality and data privacy laws of the Philippines and other jurisdictions and I/we agree to hold the Dealer and its partner banking institutions, their directors, officers, employees, representatives, agents and service providers free and harmless from any liabilities, claims, suits, costs and expenses resulting from or in connection with the authorities conferred herein.* Required
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