Originating Branch
Account Officer
Date of Application
Teachers Loan Application Form
New Loan
New Loan with Takeout
Reloan
Reloan with Takeout
INSTRUCTION: PLEASE PRINT ALL INFORMATION LEGIBLY IN CAPITAL LETTERS. Write N/A in the fields which are not applicable
LOAN APPLICATION DETAILS
Are you currently a Cebuana Lhuillier Bank
client?
YES
NO
Requested Loan Amount
Loan Term (months)
Loan Purpose
PERSONAL CONSUMPTION
PERSONAL INFORMATION
Middle Name (Gitnang Pangalan)
First Name (Pangalan)
Name of
Applicant
Date of Birth (Araw ng Kapanganakan)
Age (Edad)
Place of Birth (lugar ng kapanganakan)
Last Name (Apelyido)
Suffix
SSS or GSIS No.
Nationality (Nasyonalidad)
TIN
(mm/dd/yyyy)
Gender (Kasarian)
Male
Civil Status
Female
Email Address
Single
Widow
Married
Legally Separated
Present Address (Check box if this is your mailing address)
No./Street
Village/Subd
Brgy
Mobile No.
City/Municipality
Residential Status
Rented
Owned (mortgaged)
Living with relatives
No./Street
Village/Subd
Brgy
Residence Phone No.
Zip Code
Educational Attainment (Antas ng Pinag-aralan)
Used Free
Provincial or Permanent Address (Check box if this is your mailing address)
Prepaid
Province
Residing Since (Taon ng Paninirahan)
Owned (not mortgaged)
Postpaid
High School
College
Vocational
Post Graduate
City/Municipality
No. of Cars Owned
Others
______________
Province
Zip Code
FINANCIAL INFORMATION
Name of Employer/School
Office/School Tel. No.
Address of Employer/School
No./Street
Brgy
City/Municipality/Province
Office/School Mobile No.
Zip Code
Source of Income
Employee No
Office/School Email Address
Position
Station Code
Gross Monthly Income (PHP)
Nature of Work
Division Code
Other Source of Income (PHP)
Employment Status
Region Code
Monthly Household Expense
Date Hired
PRC ID No. (For Teaching Personnel)
No. of Dependents
SPOUSE INFORMATION (IF APPLICABLE)
Spouse's Name (Pangalan ng Asawa)
Date of Birth (mm/dd/yyyy)
Birth Place
Present Address (Check box if this is your mailing address)
No./Street
Brgy
City/Municipality/Province
Zip Code
Brgy
City/Municipality/Province
Length of Stay (Taon ng Paninirahan)
Employer/Business Address (Lugar ng hanapbuhay o negosyo)
Brgy
City/Municipality/Province
Employment Status
Position
Nature of Work/Business
Postpaid
Prepaid
Zip Code
Employer/Business Name (Pangalan ng kumpanyang pinapasukan o ng sariling kumpanya)
No./Street
Nationality
Residence Mobile No.
Provincial Or Permanent Address (Check box if this is your mailing address)
No./Street
Age
Zip Code
Source of Income
Years Operating
Educational Attainment
Email Address
High School
College
Vocational
Post Graduate
Type of ID
Gross Monthly Income (PHP/USD)
Others:
ID No.
Other Source of Income
WORK OR PERSONAL REFERENCES
Name of Reference
Address
Relationship/Position
Contact No. (Tel or Mobile No.)
------ FOR BANK'S USE ONLY ---CLIENT TYPE
Walk in
Marketed by AO
PAYROLL TYPE
MVP Referral
Referred by Other Employee
Social Media
Others, please specify
DOC CHECKLIST
FOR TAKE OUT (As Applicable)
WORK CATEGORY
RPSU
Autonomous
Payslip(s)
PLI 1
Balance
(PHP)
Appointment Letter
PLI 2
Balance
(PHP)
IDs Presented
PLI 3
Balance
(PHP)
Evaluation Sheet
PLI 4
Balance
(PHP)
Verification Result
PLI 5
Balance
(PHP)
Disbursement Instruction
SOA (Takeout)
Others (Specify)
Teaching
Non-Teaching
Remarks
RESIDENCE SKETCH/MAP
CONSENT AND UNDERTAKING
1. The Borrower hereby certifies that the provided information are true and correct and shall form part of the loan documents and the signatures indicated herein are genuine. Such information includes, but is not
limited to the following:
(a) That the presented payslip is original, correct and complete and that no hidden charges or data is omitted from it;
(b) That the said payslip is not tampered or forged;
(c ) That all my loan amortization including future amortizations from other creditors, if any, are reflected in the payslip and/or disclosed to CLRB Representative
(d) That all disclosed data in the Loan Application Form is true and correct
The Borrower's or his authorized representative's provision of any information which is not true or updated may cause Cebuana Lhuillier Rural Bank (CLRB) to automatically reject the Borrower's loan application
or cancel its approval.
2. While the loan obligation is still outstanding, the borrower agrees and undertakes to inform Cebuana Lhuillier Rural Bank, Inc. of any changes in employment status that will affect the loan arrangement with the said
bank such as, but not limited to the following:
(a) Transfer of assignment from one school to another;
(b) Filing of resignation or retirement, or
(c) That
Any all
form
myofloan
termination
amortization
of employment
including future amortizations from other creditors, if any, are reflected in the payslip and/or disclosed to CLRB Representative
3. The borrower agrees and undertakes to make over-the-counter payments of all amortizations due if not deducted by the Automatic Payroll Deduction System (APDS) of DepEd or Disbursement Office of the
Autonomous School for any reasons.
4. The Borrower authorizes CLRB to obtain relevant information as it may require concerning this application from other institutions/persons. All information obtained by or provided to CLRB pursuant to this application
shall be CLRB's property whether or not the loan is granted.
5. The Borrower agrees that this loan application shall be subject to applicable laws (including BSP circulars, rules and regulations), and policies of CLRB and undertakes to comply with/submit all loan requirements.
6. The Borrower hereby waives in favor of CLRB confidentiality of client information including without limitation, the provisions of Republic Act Nos. 1405 (The Law on Secrecy of Bank Deposits), 6426 (Foreign Currency
Deposit Act), and Section 55.1.b of Republic Act No. 8791 (General Banking Law) and any law relating to the secrecy of bank deposits for purposes of CLRB's evaluation of the Borrower's application herein. The
Borrower authorizes CLRB to: (a) pursuant to BSP Circular No. 472 Series of 2005 as implemented by BIR Revenue Regulation RR-4 2005, conduct random verification with the Bureau of Internal Revenue in order to
establish authenticity of the ITR, accompanying financial statements and such other documents/information/data submitted by the Borrower, and/or (b) obtain or disclose such information regarding the Borrower or
the loan/credit facilities applied for hereunder to any party as CLRB may deem necessary or as may be required or allowed by applicable laws. The Borrower also authorizes CLRB to request information regarding the
status of any court case to which the Borrower is a party.
7. In case of disapproval, the Borrower understands that CLRB is under no obligation to disclose the reason/s for such disapproval.
8. The Borrower further certifies that the proceeds of the loan, if this application is approved, will be used solely for the purpose stated in this application.
9. The Borrower hereby authorizes CLRB to contact the Borrower regarding the status of the Borrower's loan application, details concerning the Borrower's approved/ availed loan via e-mail, telephone, text message,
etc. Further, the Borrower authorizes CLRB and its affiliates, and their respective representatives and agents ("PJ Lhuillier Group") to provide support information notices, offers and announcements for the purpose of
marketing, cross selling and sales offers to the Borrower via email, as well as broadcast messaging service, multi-media messaging service, and/or short messaging service as these terms are defined in the regulations of
the National Telecommunications Commission (NTC). The Borrower agrees to hold CLRB free and harmless against any loss, injury or damage that the Borrower may suffer in relation to any notification/announcement
sent by CLRB to the Borrower in the format stated herein. It is agreed and understood that unless and until CLRB is in receipt of written notice from the Borrower not to be sent such messages, the Borrower's authority
as given herein shall be deemed continuing, valid and effective.
10. In the event of the approval of loan application for salary loan and any refundables, the borrower hereby authorizes Cebuana Lhuillier Rural Bank to credit to the borrower's nominated depository account.
APPLICANT SIGNATURE OVER
PRINTED NAME
Date
REFERRER'S INFORMATION & CONSENT
Name
MVP Number
Contact Number
Referrer consents to the processing of personal information by the Cebuana Lhuillier Rural Bank, Inc., its directors, officers, employees, advisers, consultants, auditors, agents and representatives for purposes of (i) carrying
out,management, performance and development of its products and services (ii) pursuit of its marketing; promotional, communication, commercial and research objectives;-(iii) usual business transactions and (iv) compliance with the
requirements of applicable laws and/or government regulators or supervisory bodies. This constitutes as express consent under the applicable confidentiality and data privacy laws of the Philippines given, by the Referrer specifically
allows the, Cebuana Lhuillier Rural Bank, Inc. to:
(a) collect, use, record, store, consolidate, retrieve, and process ("process") of Information;
(b) outsource the processing of Information to service providers wherever located.
(c) verification or validation of Information from any and all sources and In any reasonable manner
(d) disclose and share the information or data to:
(i.) Cebuana Lhuillier Rural Bank, Inc., and affiliates and; related interests {the "P.J. Lhuillier Group of Companies");
(ii.) service providers outsourced by the Bank ;
(iii) such other persons or entities that the Bank or any member of the PJ Lhuillier Group, may deem necessary to perform the above activities.
shall hold the Cebuana Lhuillier Rural Bank,lnc. and each member of the PJ Lhuillier Group, free and harmless from any and all liabilities, claims, damages and suits of whatever kind and nature, that may arise" in connection with the
performance of the activities related with the authorization conferred by the Referrer hereunder.
CONFORME:
Date
Signature over Printed Name of the Referrer
------ FOR BANK'S USE ONLY ----
RECEIVED BY
DATE
RECEIVED BY
DATE