Annex A

APPLICATION FOR ACCREDITATION/RENEWAL OF ACCREDITATION TO THE DBP

SALARY LOAN FACILITY
Name of Agency: New Renewal Increase / Decrease in Line Limit
Client/Employer Code:
Date of Application:
Office Address: Telephone No.:
No. of Personnel Qualified to Borrow under the Program:
OTHER INFORMATION
A. Deposit Accounts with DBP:
Account Name Account No. Date Account Was Opened Branch

B. Loan Accounts with DBP:

Type of Loan Date of Loan Approval Outstanding Balance Branch

C. Others:
_____________________________________________________________________________________
_____________________________________________________________________________________

AUTHORIZED SIGNATORIES TO THE SALARY LOAN FACILITY AND TO ENDORSE LOANS

Per Sanggunian/Board Resolution No. _____ dated __________
1. Name: 2. Name:
Position: Position:
Telephone No.: Telephone No.:
Signature: Signature:

I hereby certify that the information given above are true and correct to the best of my knowledge and belief. Any
significant information withheld from this application or any misrepresentation of information herein provided
maybe used as sufficient ground for the disapproval of this application.

______________________________ ________________________ ______________

Signature over Printed Name Designation Date
TO BE FILLED-UP BY DBP
All accreditation requirements are hereby complied with. Attached herewith are: 1) Request for Credit Checking dated
___________ duly received by _______, 2) Record/s evidencing that Participant has no record of non-compliance to the
mandatory amount of net take home per COA audit (as applicable) and (Others) __________.

_____________________________ _________________________
Account Officer Branch Head
Existing Credit Line (for Renewal): P ______________
OPB of Employees as of ________: ______________ Utilization Rate: _________%
Total Available Credit Line : ______________ BEDR Cap: _________%
Proposed New/Additional Line Amount: P ______________ Past Due Rate Cap: _______%

Total Credit Line for Approval: P ______________

Branch Head: RMC Head:

_______________________ _________________________
FOR HEAD OFFICE APPROVAL
Reviewed by: Recommending Approval: Approved by:

FVP MARK DENNIS S. TAN___ FSVP MA. TERESA M. JESUDASON EVP ANTHONY T. ROBLES
Head, BBS-Consumer Finance Dept. Head, BBS- Sales and Distribution Group Head, Branch Banking Sector