AUTO LOANS APPLICATION FORM

IMPORTANT NOTICE: PLEASE READ:
IN-ORDER TO FACILITATE YOUR APPLICATION PLEASE FILL UP THIS FORM COMPLETELY.

PLEASE SEND 2 VALID IDS AS SOON AS YOU FILL OUT THE FORM. EMAIL AT tophe@mymitsubishi.com.ph

* Information provided will be treated confidential, for reference use only.
* Please fill out all required fields.

* Email Address

PRIMARY APPLICANT

* LAST NAME * FIRST NAME * MIDDLE NAME (FULL)

* BIRTHDAY (mm/dd/yy)

* BIRTH PLACE

* CIVIL STATUS

* CITIZENSHIP

* RESIDENCE LANDLINE NO.

* MOBILE NUMBER

NO. OF DEPENDENTS / AGES?

* COMPLETE ADDRESS (Philippines)

* TYPE

* LENGTH OF STAY

PRIMARY APPLICANT - BUSINESS / WORKING INFORMATION

* EMPLOYED/BUSINESS - COMPANY

* POSITION & DEPARTMENT

* YEARS OF SERVICE

* COMPANY'S COMPLETE ADDRESS

TIN NUMBER OF APPLICANTS

* Business Tel. No.

* MONTHLY INCOME

SPOUSE / CO-MAKER

INSTRUCTION ON CO-MAKER (please read very important)

*If both husband and wife are working abroad or if single - please nominate a co-maker who resides in the philippines and is the recepient of the remittance (immediate family, parents, siblings or 1st degree relative).

* If salary of the principal is insufficient, the applicant must nominate a co-maker.

* If Married and spouse resides in the philippines- Make sure to Complete your spouse's information and contact numbers.

RELATIONSHIP TO CO-MAKER

CONTACT NO. (please provide - must be in the philippines)

*LAST NAME * FIRST NAME * MIDDLE NAME (FULL)

Birthdate (mm/dd/yr)

Birth Place

RESIDENCE LANDLINE NO.

SPOUSE OR CO-MAKER'S - BUSINESS / WORKING INFORMATION

COMPANY

POSITION & DEPARTMENT

YEARS OF SERVICE

COMPANY'S COMPLETE ADDRESS

BUS. TELEPHONE NO.

Monthly Income

FOR BOTH WORKING ABROAD ONLY (PROVIDE COMPLETE NAME AND CONTACT NO. OF CONTACT PERSON HERE IN THE PHILIPPINES, MUST BE IMMEDIATE FAMILY)

COMPLETE NAME - TELEPHONE NOS./ CELLPHONE NOS.

* BANK & BRANCH (ex. BDO - SM NORTH / BPI FAMILY - E.Rod/ BDO - Real Tacloban)

* CAR MODEL (ex. Mitsubishi Adventure GLX)

* DOWNPAYMENT

* YEARS TO PAY

* PREFFERED DATE OF RELEASE

Other car / Brand you are considering?

COMMENT BOX
REGARDING CREDIT ISSUES WITH THE BANK?
Do you have cancelled card, Bounced Check, Pending Court Cases? If yes please indicate year.
TELL US SO WE COULD HELP YOU MORE.

Please Check the Box after reading the agreement :)

Yes, I Agree

* Terms and Agreement (FAVOR PLEASE)
Just a simple consideration.

* For those that were approved, please be considerate in letting me know if you are to pursue or not to avoid wasting time, money and effort through my follow-ups.

*In every application, I do extreme efforts to make sure everyone gets an approval

*If you're not sure to avail any of our units, please disregard filling out the application form. (it's very unfair po if I have you approved but then not going to avail, kawawa ibang clients ko that badly needed my help and approval, yet I focused on your approval - also it's unfair to banks who made the effort of conducting background checking your home, business but not going to avail)

*Our promos, quotation are the best deal you could ever find to make sure that all my clients are satisfied and happy.
Your kind response will be greatly appreciated
Thank you. =)

For clarifications, concerns and more inquiry please dont hesitate to contact:

Christopher "Tophe" Serrano Villarina

Sales Executive of MITSUBISHI, CITIMOTORS, INC.

sun: 0922-8629032

Globe: 0917-5762021

Smart: 0999-9928182

Tel No. (02) 3470042

email: tophe@mymitsubishi.com.ph

cc: mitsubishi_tophe@yahoo.com

* Indicates Response Required