B7 BAJAJ 3S Samal Island APPLICATION FORM

We are located @ Unit 2-3 Triple Building, Brgy Villarica, Babak Dist. Island Garden City of Samal, Davao Del Norte.
Landmark (Beside Tagum Coop and One Puhunan).

You may also contact us at: 0995 454 1318 / 0960 311 5327
CREDIT APPLICATION FORM
BRANCH:
Facebook NAME:
BRAND
BAJAJ MODEL
Specific unit to modified
Specific unit color
LCP
DOWN PAYMENT
AMOUNT FINANCE
MONTHLY AMORTIZATION
TERMS OF LOAN
TOTAL PRICE
(All informations will be treated CONFIDENTIAL)
PERSONAL DATA
First Name
Middle Name
Last Name
Mother's Maiden Name
Date of Birth

MonthDayYear
Date
Age
Birth Place
Civil Status
Citizenship
Contact Number
Gmail
TIN NUMBER (OPTIONAL)
Complete Address

House No./Block/Lot/Phase

Street Name/Barangay

City/MunicipalityState / Province

Zip Code
Length of Stay
Number of Years / Months
Name of Land Lord ( if rental)
Monthly Rental
Contact Number of Land Lord
Provincial Address (If any)
Length of Stay in Province
Number of Years / Months
APPLICANT EMPLOYMENT DETAILS
SOURCE OF INCOME
EMPLOYMENT DETAILS
APPLICANT POSITION
ASSIGNED WORK
DATE HIRED:

MonthDayYear
Date
LENGTH OF STAY IN WORK
Number of Years / Months
NAME OF EMPLOYER
NATURE OF WORK
ADDRESS OF WORK / AGENCY
MONTHLY SALARY
TEL NO. / CEL NO OF COMPANY
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
NAME OF EMPLOYER (leave blank if Not Applicable)
ADDRESS OF WORK / AGENCY
MONTHLY SALARY (leave blank if Not Applicable)
Tel./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, REMMITANCE 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
Sales Partner / Agent Code / Sales Tagging
SP CODE (Manual Encode)
Please verify that you are human
Should be Empty:

CREDIT APPLICATION FORM

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