SOURCE OF APPLI:

ELBRUS MOTOR CORP. Credit Application

(HONDA SAN PABLO) Sales Consultant:
Date: Sales Manager:
PERSONAL INFORMATION

Borrower's Name: Date of Birth:

First Middle Last mm dd yy

Civil Status: Single Married Widowed Separated No. of Dependents:

Nationality: Filipino Others: (Pls. Specify) _______________________________ Gender: Male Female

Home Address: Length of Stay: Yrs. Mos.

Home no.
Provincial Address:
Mobile No.:
Place of Birth:

Residential Status: Owner (Mortgaged) Owner (Not Mortgaged) Other No.:

Owned Car: Yes, If so, how many? No Taxpayer's ID No.:

Bank/ Branch: Account Number: Email Add:

WORK EXPERIENCE

Employment: Private Sector Government Self-Employed Position / Title:

Employer / Business: Business Tel.:

Business Address: Mobile No.:

Nature of Business: Length of Stay: yrs Mos.

Monthly Income:
SPOUSE PERSONAL DETAILS

Spouse name: Date of Birth:

First Middle Last mm dd yy

Employment: Private Sector Government Self-Employed Position / Title:

Employer / Business: Business Tel.:

Business Address: Mobile No.:

Nature of Business: Length of Stay: yrs Mos.

Place of Birth: Monthly Income:

CO-MAKER PERSONAL DETAILS
Co-Maker Date of Birth:
First Middle Last mm dd yy
Relationship:

Employment: Private Sector Government Self-Employed Position / Title:

Employer / Business: Business Tel.:

Business Address: Mobile No.:

Nature of Business: Length of Stay: yrs Mos.

Place of Birth: Monthly Income:

CO-MAKER PERSONAL DETAILS

Co-Maker Date of Birth:

First Middle Last mm dd yy
Relationship:

Employment: Private Sector Government Self-Employed Position / Title:

Employer / Business: Business Tel.:

Business Address: Mobile No.:

Nature of Business: Length of Stay: yrs Mos.

Place of Birth: Monthly Income:

PERSONAL / TRADE REFERENCES

Name Address Telephone Number

VEHICLE DETAILS
Make / Model: Cash Price: Downpayment:
Amount Finance: Terms: Months:
I / we certify that all above informations are true and correct to the best of my knowledge. I / We also hereby authorize and give my consent to
ANC GROUP OF COMPANY or ELBRUS MOTOR CORP. and its accredited third- party partners to collect, store and process and share my information
provided that such collection, storage and processing and sharing are in accordance with the provisions of Republic Act No. 10173 or the
Data Privacy Act of 2012, its implementing Rules and Regulations and other Laws, rules and regulations relating data privacy.

Signature of Borrower Date Signature of Spouse / Co-Maker Date