U4 BAJAJ 3S Sta. Cruz APPLICATION FORM

We are located @ P. Guevara Avenue, Poblacion II, Sta. Cruz, Laguna

You may also contact us at: 0960 300 8746 / 0991 887 1551 / 0994 877 5326
MOTORCENTRAL CREDIT APPLICATION
BRANCH:
Facebook NAME:
BRAND
BAJAJ MODEL
Specific unit to modified
Specific unit color
LCP
DOWN PAYMENT
AMOUNT FINANCE
MONTHLY AMORTIZATION
FOR BAJAJ TERMS OF LOAN
TOTAL PRICE
(All informations will be treated CONFIDENTIAL)
PERSONAL DATA
First Name
Middle Name
Last Name
Mother's Maiden Name
Type a question
Date of Birth

MonthDayYear
Date
Age
Birth Place
Civil Status
Citizenship
Contact Number
Please enter a valid phone number.Format: (0000) 000-0000.
Gmail
TIN NUMBER (OPTIONAL)
Complete Address

House No./Block/Lot/Phase

Street Name/Barangay

City/MunicipalityState / Province

Postal / Zip Code
Length of Stay
Number of Years / Months
Name of Land Lord ( if rental)
Monthly Rental
Contact Number of Land Lord
Please enter a valid phone number.Format: (0000) 000-0000.
Provincial Address (If any)
Length of Stay in Province
Number of Years / Months
APPLICANT EMPLOYMENT DETAILS
SOURCE OF INCOME
EMPLOYMENT DETAILS
APPLICANT POSITION
DATE HIRED:

MonthDayYear
Date
LENGTH OF STAY IN WORK
Number of Years / Months
Company Name
Nature of Company:
Others Please Specify
Nature of Company:
ADDRESS OF WORK / AGENCY
MONTHLY SALARY
Contact Number of Company
Please enter a valid phone number.Format: (0000) 000-0000.
SELF-EMPLOYED / OWN BUSINESS
NAME OF BUSINESS
Monthly Income
REMARKS
DEPENDENTS INFORMATION

(Leave blank if Not Applicable)
NAME OF DEPENDENT 1
RELATIONSHIP TO DEPENDENT
AGE OF DEPENDENT
NAME OF DEPENDENT 2
RELATIONSHIP TO DEPENDENT
AGE OF DEPENDENT
Do You have a Spouse or Live-in Partner?
SPOUSE / LIVE-IN PARTNER DATA

(leave blank if Not Applicable)
First Name
Middle Name
Last Name
Age
Date of Birth

MonthDayYear
Date
Birth Place
Contact Number
Citizenship
Occupation
Present Address
Length of Stay in Work
Position
Company Name (leave blank if Not Applicable)
ADDRESS OF WORK / AGENCY
MONTHLY SALARY (leave blank if Not Applicable)
Cel No.
Format: (0000) 000-00000.
Do You have other source of income?
OTHER SOURCE(S) OF INCOME / REMITTANCE
REMITTANCE

Leave Blank if Not Applicable
From Whom
Monthly Remittance
Amount
Relationship
OTHER

Leave Blank if Not Applicable
NATURE (Other)
Monthly Income (Other)
REMARKS (Other)
Character Reference
1
Relationship
Phone Number
Please enter a valid phone number.Format: (0000) 000-0000.
Address
2
Relationship
Phone Number
Please enter a valid phone number.Format: (0000) 000-0000.
Address
Signature (Buyer)
FULL NAME
DATE OF FILL OUT

MonthDayYear
LIST OF REQUIREMENTS FOR EMPLOYED

2 VALID IDS W/ 3 SIGNATURE FRONT

PROOF OF BILLING LATEST ( ELECTRIC, WATER OR INTERNET BILL)

PROOF OF INCOME ( 1 MONTH LATEST PAYSLIP, REMITTANCE SLIP, BRGY BUSINESS PERMIT)

SKETCH LOCATION OF YOUR HOUSE
LIST OF REQUIREMENTS FOR TODA MEMBER

TODA Certificate

PRANGKISA

OR/CR
List of Requirements (Optional)
2 VALID ID WITH 3 SIGNATURE FRONT

Cancelof
PROOF OF BILLING ( ELECTRIC, INTERNET, WATER BILL )

Cancelof
PROOF OF INCOME ( PAYSLIP FOR 1 MONTH, BUSINESS PERMIT, REMITTANCE SLIP FOR 3 MONTHS, WEEKLY PAYOUT FOR 1 MONTH )

Cancelof
SKETCH ( FROM YOUR HOUSE TO THE NEAREST LANDMARK IN YOUR AREA )

Cancelof
TODA Certificate

Cancelof
Prangkisa

Cancelof
OR/CR

Cancelof
How's your experience in filling-out the ONLINE APPLICATION FORM?
Comment about application form
Application Result
Agent Code / Sales Tagging
SP CODE (Manual Encode)
Please verify that you are human
Should be Empty:

MOTORCENTRAL CREDIT APPLICATION

PERSONAL DATA

APPLICANT EMPLOYMENT DETAILS

EMPLOYMENT DETAILS

SELF-EMPLOYED / OWN BUSINESS

DEPENDENTS INFORMATION

SPOUSE / LIVE-IN PARTNER DATA

OTHER SOURCE(S) OF INCOME / REMITTANCE

REMITTANCE

OTHER

Character Reference