ACPC SURVIVAL AND RECOVERY (SURE) ASSISTANCE PROGRAM FOR TYPE 1
EXPANDED SURE AID RECOVERY PROJECT
Loan Application Form with Agreement &Promissory Note
I hereby apply for an ( )Agri-Production Loan ( ) Agri-Microfinance Loan ( ) Other types of Loan: under
the EXPANDED SURE AID AND RECOVERY PROJECT in the amount of PESOS:
__________________________________________ (P___________).
I hereby swear that:
(1) I am up-to-date in the payment of my existing loan (if any);
(2) I have no pending application for loan from other creditors for the same purpose;
(3) I am not a party to any pending administrative or criminal case; and
(4) the statements above are true and correct to the best of my knowledge and the
application is made for the purpose and consideration indicated above.
I agree that should there be any misrepresentation discovered, the COOPERATIVE BANK OF CAGAYAN
may cause the outright disapproval of the loan application and if the loan has already been granted,
the same may immediately declare the loan due and demandable.
PROMISSORY NOTE
PN Date: __________________ Maturity Date: _____________________
For value received, I hereby promise to pay to the order of COOPERATIVE BANK OF CAGAYAN, as
Attorney-In-Fact of the Agricultural Credit Policy Council (ACPC), under the Program for Unified Lending
to Agriculture (ACPC SURVIVAL AND RECOVERY (SURE) ASSISTANCE PROGRAM / Expanded Sure Aid
Recovery Project) with office address located at____________________________, or at its
branch/unit _____________________ without need of notice or demand, the principal with an interest
rate of zero percent (0%) and a service charge of three percent (3%) per transaction payable within a
period of ten (10) years in the manner as shown in the next pages plus other applicable fees/charges
(if any) of ______ subject to the terms and conditions as stipulated in the approved Lending Policies
and Procedures for ACPC SURVIVAL AND RECOVERY (SURE) ASSISTANCE PROGRAM / Expanded Sure
Aid Recovery Project, which I acknowledge to have read and clearly understood.
In case of any default in the principal payment as herein agreed upon, the entire principal balance of
this note shall become due and demandable, at the option of the holder. Each party to this note
whether Maker or Co-Maker, Endorser or Guarantor, or Surety, severally waives presentation of
payment, demand protest and notice of protest and dishonor of the same.
I hereby agree and authorize ACPC, to encumber, assign or sell to any person or entity any right which I
may have under this Note and/or any assignment, mortgage lien, pledge/s or other encumbrances
constituted in favor of ACPC pursuant to the provisions of the loan agreement and this Note, if any.
The consent herein granted is recognized and acknowledged by me as a waiver to all intents and
purposes of whatever right I may have to notice of actual encumbrance or assignment.
___________________________________ ___________________________________
Signature over Printed Name of Borrower Signature over Printed Name of Spouse
___________________________________
Signature over Printed Name of Co-Maker
Amount Due
Due Date Total
Principal Interest
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
TO BE FILLED-OUT BY LENDING CONDUIT
New/Existing Loan ( ) Endorsement from Credit Committee
Date Approved __________________________ Date received: _________________________
Amount Approved _______________________
Outstanding Balance _____________________
Arrearages _____________________________
Processed by: Reviewed by: Approved by:
_____________________ _______________________ _______________________
AFFIDAVIT OF GOOD FAITH
We severally swear that the Assignment contained therein is made for the purpose of securing the
obligation specified in the conditions thereof, and for no other purpose, and that the same is a just valid
obligation, and not one entered into for the purpose of fraud.
LENDING CONDUIT BORROWER
COOPERATIVE BANK OF CAGAYAN ____________________________
Name of Conduit Printed Name
_______________________________ ____________________________
Signature over Printed Name/Authorized Person Signature
REPUBLIC OF THE PHILIPPINES)
) S.S.
At the above stated locality, on this ____ day of __________ 2020, before me personally appeared:
Name Government-issued ID/Comm. Cert. Number Date/Place Issued
Known to me to be the same persons who executed the foregoing instrument who subscribed under oath to the
matters set forth in the loan application appearing on the reverse side hereof and acknowledged the same to
their free and voluntary act and deed and that of the institution represented herein.
NOTARY PUBLIC
Doc No. __________;
Page No. _________;
Book No. _________;
Series of 2020
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS:
DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory
note. -Fully filled out SURE Loan Application form and Promissory
-One (1) Government-issued ID with picture note.
-One (1) 1x1 ID picture -One (1) Government-issued ID with picture
-Proof of registration/Enrollment in RSBSA -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS:
DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory
note. -Fully filled out SURE Loan Application form and Promissory
-One (1) Government-issued ID with picture note.
-One (1) 1x1 ID picture -One (1) Government-issued ID with picture
-Proof of registration/Enrollment in RSBSA -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RS
DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory note.
-One (1) Government-issued ID with picture
-One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory note.
-One (1) Government-issued ID with picture
-One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS: DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory -Fully filled out SURE Loan Application form and Promissory
note. note.
-One (1) Government-issued ID with picture -One (1) Government-issued ID with picture
-One (1) 1x1 ID picture -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA -Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS:
DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory
note. -Fully filled out SURE Loan Application form and Promissory
-One (1) Government-issued ID with picture note.
-One (1) 1x1 ID picture -One (1) Government-issued ID with picture
-Proof of registration/Enrollment in RSBSA -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA
DOCUMENTARY REQUIREMENTS:
DOCUMENTARY REQUIREMENTS:
-Fully filled out SURE Loan Application form and Promissory
note. -Fully filled out SURE Loan Application form and Promissory
-One (1) Government-issued ID with picture note.
-One (1) 1x1 ID picture -One (1) Government-issued ID with picture
-Proof of registration/Enrollment in RSBSA -One (1) 1x1 ID picture
-Proof of registration/Enrollment in RS
-One (1) 1x1 ID picture
DOCUMENTARY REQUIREMENTS: -Proof of registration/Enrollment in RSBSA
-Fully filled out SURE Loan Application form and Promissory DOCUMENTARY REQUIREMENTS:
note.
-One (1) Government-issued ID with picture
-Fully filled out SURE Loan Application form and Promissory
note.
-One (1) Government-issued ID with picture
-One (1) 1x1 ID picture
-Proof of registration/Enrollment in RSBSA
