ACCOUNTABILITY
ACCOUNTABILITY
ACCOUNTABILITY
Brand and Model Brand/Model SRP Mode of Payment OTC Auto Debit
Brand New Used/Repossessed
PDCs
APPLICANT/BENEFICIARY
BORROWER' S INFORMATION
INFORMATION
Last Name First Name Middle Name Civil Status Gender
Permanent Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)
Present Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)
INCOME DETAILS
Source of Funds
Employed - Private Employed - Govt. Employed - OFW/Immigrant Self Employed with Business Self Employed Professional Others _____________________
Employer Name/Name of Business Nature of Work
FAMILY INFORMATION
Name of Spouse Date of Birth
Employed Self Employed
INFORMATION OF DEPENDENTS
Bank Name of Children/Dependents Maturity
Age
1.
2.
3.
CO-BORROWER
BORROWER'
INFORMATION
S INFORMATION
(OTHER THAN SPOUSE)
Last Name First Name Middle Name Civil Status Gender
Permanent Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)
Present Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)
INCOME DETAILS
Source of Funds
Employed - Private Employed - Govt. Employed - OFW/Immigrant Self Employed with Business Self Employed Professional Others _____________________
Employer Name/Name of Business Nature of Work
Please sketch location of your residence in relation to the nearest transportation line at the box below.
Robinsons Bank Corporation is supervised by Bangko Sentral ng Pilipinas (BSP). For any concerns, you may contact us at (02) 8637-2273 and [email protected]. MLAF-Version October 2021
You may also contact BSP Financial Consumer Protection Department at (02) 8708-7087 and [email protected].
MEMBER: PDIC. DEPOSITS ARE INSURED BY PDIC UP TO PHP 500,000 PER DEPOSITOR.
CREDIT
LOAN INFORMATION
REFERENCES
Amount/Type
Bank Bank Bank Branch Branch Account No.
Bank Balance Tel. No.
Current Account
Savings Account
Time Deposit
Card Name Card Number Credit Limit Personal Reference Tel. No.
CREDIT CARD
ASSET
Card Name Card Number Credit Limit Personal Reference Tel. No.
LIABILITIES
By signing this form, I/we hereby certify that the information provided herein are true, accurate, and complete in connection with my/our Motorcycle Loan (the
“Product”) with Robinsons Bank Corporation (the "Bank"). I/We agree to notify/update the Bank of any change in any of the information supplied in this form.
l/we hereby authorize the Bank to conduct business, deposit, employment verifications, credit checking including but not limited to telecommunications and
utility credit scoring, property inspections, and other such related inquiries relative to information indicated in this application. I/we understand and authorize
the Bank to verify and investigate the same from whatever source it may consider appropriate. Furthermore, l/we understand that my/our falsification of any of
the information, including the enclosed/attached documents, if any, is sufficient ground for legal action(s) against me/us and the rejection of my/our loan
application. I/We further understand that should my/our loan application be denied, the Bank has no obligation on its part to furnish me/us with reason for such
rejection and/or to return my/our application form and documents.
I/We hereby authorize the Bank to disclose and report to the U.S. Internal Revenue Service (IRS)/Bureau of Internal Revenue (BIR) the pertinent information
as required under FATCA, if applicable.
I/We acknowledge to have read, understood and agreed to be bound by the terms and conditions governing the Product of the Bank which I/we opened or
availed of, and which were provided to me/us, received by me/us, and/or available to me/us via www.robinsonsbank.com.ph, as the same may be amended
from time to time. That by voluntarily entering into this transaction with the Bank, I/we am/are fully aware that I/we are considered indebted to the Bank upon
receipt of the loan proceeds.
I/we agree to indemnify and hold the Bank, its directors, officers and employees free of any claims l/we may have against the broker-referror who referred me/us
for the Bank's financing. I/We agree to comply with any and all rules, regulations, and laws pertaining to Anti-Money Laundering measures, laws, and
regulations and hereby unconditionally agree to hold the Bank free and harmless from any and all damages, suits, costs, and expenses related directly or
indirectly, with your compliance with such laws and/or regulations.
I/We hereby acknowledge that I/we have read, fully understand, consent to and agree to be governed by the attached Privacy Consent and Notice (PCN) as
well as the provisions of Republic Act No. 10173 or the Data Privacy Act of 2012.
This certification and authorization remains valid, effective, and subsisting until otherwise revoked or cancelled in writing by me/us.
Signature of Borrower over Printed Name and Date Signature of Spouse/Co-Borrower over Printed Name and Date
By signing the space provided below, I/we hereby apply for Robinsons Bank (RBank) Credit Card and I/we undertake to submit documents as may be deemed
necessary by the Bank. I/We authorize the Bank to conduct random verification with government agencies or third parties to establish the authenticity of the
information declared and/or documents submitted and I/we hereby waive the confidentiality of the rules and laws as applicable in order to facilitate the random
verification. I/We further understand that the issuance of RBank Credit Card shall be subject to credit evaluation and discretion of the Bank and terms and
conditions applicable to RBank Credit Card. I/We likewise agree to be bound by the terms and conditions of the Undertaking.
Signature of Borrower over Printed Name and Date Signature of Spouse/Co-Borrower over Printed Name and Date
We allow access to your personal data to trusted and authorized third-party companies,
businesses and vendors engaged with Robinsons Bank who provide services including,
among others: