Secured Loan Form

  • PROGRESSIVE RURAL BANK, INC.

  • Information Sheet

    Note: Please fill up the form completely to avoid delay in processing your loan. Co-borrower/s or co-maker/s other than the borrower's spouse should accomplish a separate Loan Application Form. Please check the appropriate box.

  • *
  • Date:*
     - -
  • Term of Loan*
  • Proposed Mode of Payment*

  • A. Personal Data

  • Date of Birth:*
     - -

  • B. Family Background

  • Civil Status*
  • Date of Birth:
     - -
  • Rows

  • C. Residences

  • Residence Ownership*

  • D. Assets:(i.e. Real Estate Properties/ Motor Vehicle, etc.)

  • Rows

  • E. Savings:(SA) Current (CA)/Money Securities and/or Other Investments Verification

  • Rows

  • F. Outstanding Obligation/s: (Housing, Auto, Salary Loan, Credit Card Balance and/ or other existing loan/s)

  • Rows

  • G. Employment Data

  • Applicant

  • Inclusive date of Service*
     - -

  • Spouse

  • Format: (000) 000-0000.
  • Inclusive date of Service
     - -

  • H. Business Data

  • Format: (000) 000-0000.
  • Registered with
  • Date Registered
     - -

  • H. Income and Expenses:

  • Rows
  • Rows

  • J. Collateral/s Offered:

  • Classification*
  • Rows
  • Classification*
  • Rows

  • Co-Maker's Statement

    I am aware that as a co-maker, I am jointly and solidarity liable with the principal borrower for the loan obtained through this application under the term and conditions the principal borrower/s has agreed with Progressive Rural Bank, Inc. and I agree to pay the said bank any outstanding principal. interest and penalties thereof upon written demand by Progressive Rural Bank, Inc. in case if default by the borrower/s.

  • Borrower's Statement

     

    I/We hereby certify that all information contained in this information sheet are correct and complete. I/We authorize the Progressive Rural Bank, Inc. to obtain such information as you require concerning the statements made in this application and that the source to which you make apply are authorized to provide the information relative in this application. I/We agree that his application may remain your property whether the loan is granted or not.

    I/We hereby authorize Progressive Rural Bank, Inc. to check/verify by banks/creditors on the status of my deposits/liabilities.

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