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LOAN APPLICATION FORM

DATE (MM/DD/YYYY): ____________

Source: Loan Consultant: _______________ SR/SRA/SRO: _______________

Mr. Kenneth Lopez
Dealer: _______________ GDFI Employee: ______________ Others: _______________

Type of loan applied for: Collateral Details:

Collateral Non-collateral For Vehicles:

If with Collateral, what type? Year: _______ Make/Model: _____________________

__________________________________ Color: ________________
Plate No.:_________ Mileage (Kms): _______
Loan purpose: ______________________ Place of Registration:____________
Loan amount applied:_____________
Loan term: ____________________ For Real Estate:

How did you know about GDFI? TCT No: ____________ CTC No.: ______________
Location: ________________
Walk-in Client GDFI Website
Note:
GDFI Employee Loan Consultant - For Vehicles: All details SHOULD match with the
vehicle’s Official Receipt and Certificate of
Social Media ____________________ Registration (OR/CR)
- For Real Estate: The property is located in selected
First-time Borrower of GDFI? areas nationwide."
Yes No - GDFI will perform the necessary investigation to
determine if the declared collateral is free from any
For the complete list of products offered by lien and encumbrances as of the date of this loan
GDFI, please go to https://gdfi.com.ph/ application.

BORROWER’S PERSONAL INFORMATION (MANDATORY)

(Last Name, First Name, Middle Name, Suffix) Civil Status
Full Name DELLOMES, MARIA GINA PADERNOS
Single
Married
Date of Birth / (MM/DD/YYYY) (City/Municipality) Gender (Male or Female)
Place of Birth 09/21/1970 Female
QUINAPONDAN, EASTERN SAMAR
Present Length of Stay
2331 AMAIA SKIES AVENIDA, DOROTEO JOSE CORNER TOMAS____
6MAPUA STREETS,
year/s STA CRUZ, MANI
3____month/s
Address
Permanent Length of Stay
2331 AMAIA SKIES AVENIDA, DOROTEO JOSE CORNER TOMAS 6MAPUA STREETS, STA CRUZ, MANI
Address 3
____ year/s ____month/s
Provincial Length of Stay
BLOCK 18 LOT 10 BARANGAY BANABA, SILANG, CAVITE
Address ____ year/s ____month/s
Primary Phone Number Mobile Number E-mail Address/es
Contact Details 09157203999 09157203999 [email protected]
Citizenship or
Filipino Others If “Others”, please specify:
Nationality
TIN / SSS / GSIS 177-784-203 CRN-0066-0011-3222-7
TIN ______________ SSS No. NA
_____________ GSIS No. _________________
Number
School Name: __________________________________________
PHILIPPINE CHRISTIAN UNIVERSITY

School Last
Grade / Level / College course: ______________
PhD
Attended
Year Graduated (last year of stay): ___________
2022

GDFI Loan Application Form – April 2024

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Owned (Not mortgaged) Rented: If “Rented”– (PHP/month) ____________

Owned (Mortgaged) If “Mortgaged” – (PHP/month) _________________
13000.00
Used Free
House
• If “Rented”, from whom? Individual/Bank/Company): ____________________
Ownership
• If “Mortgaged”, from whom? (Individual/Bank/Company): _________________
UNIONBANK
• If “Free”, owned by whom? (Individual/Bank/Company): __________________

Owned (Not mortgaged) Rented: If “Rented”– (PHP/month) ____________

Owned (Mortgaged) If “Mortgaged” – (PHP/month) _________________
House Used Free
Ownership of
• If “Rented”, from whom? Individual/Bank/Company): ____________________
Provincial
• If “Mortgaged”, from whom? (Individual/Bank/Company): _________________
Address
• If “Free”, owned by whom? (Individual/Bank/Company): __________________
INHERITANCE HOME

Name of
Dependents Relationship with
Age School Last Attended
(Not married or the Borrower
employed)
GIAN JEROM 27 SON
DE LA SALLE ARANETA UNIVERSITY COLLEGE OF VETERINARY
THEA REGINA 24 DE LA SALLE COLLEGE OF SAINT BENILDE DAUGHTER

INCOME INFORMATION
Name of Employer: Name of Business: Not Applicable:
Name of SENATE OF THE PHILIPPINES PUBLIC GOVERNMENT
Employer /
Length of stay:
Business Monthly Income: PHP 177,000.00
____ year/s ____month/s
Business Tel. No.
Employer / GSIS BUILDING, MACAPAGAL AVENUE, PASAY CITY
Business 85526601 LOCAL 3321
Professional Regulation Commission (PRC) License
Address
No. (if applicable).
Source of Employment Remittance Pension/Retirement Commissions
Income / Funds Business Interest Income Sale of Assets
(Tick all applicable)
1. Agriculture / Animal Farming 13. Finance/Insurance/Securities
2. Food Services/Food Processing 14. Manufacturing
3. Real Estate / Leasing 15. Utilities
1 4. Business Process Outsourcing 16. Foreign Exchange
/ Knowledge Process Outsourcing Dealer/Money
5. Government Service Changer/Remittance Agent
Nature of Work 17. Maritime / Shipping
/ Business 6. Tourism
7. Casino/Gaming Club 18. Foundation
8. IT / Software 19. Medical / Health Services
9. Transportation 20. Others _____________
EDUCATION (PROFESSOR)

10. Construction
11. Law / Accounting/Auditing Firm
12. Wholesale / Retail Trade
Do you own a Year: ___________ Make / Model: __________________ Color: _________
motor Plate No.:_________
vehicle/s? Mileage (Kms): __________ Place of Registration:____________
(Not used as Year: ___________ Make / Model: __________________ Color: _________
collateral for this loan Plate No.:_________
application) Mileage (Kms): __________ Place of Registration:____________
Do you own a bank account? Yes No
(If “Yes”, please fill out BORROWER’S BANK ACCOUNTS details)
CHARACTER REFERENCES (not living in the same household)
Name Address Contact number/s
MS. DAISY RAFAL NOVALICHES, QUEZON CITY 09399066952
ATTY TEODORA ABUNDO
ESPANA, MANILA 09178710992
DR MEDINA CASTRO MALABON, METRO MANILA 09165132933

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TRADE REFERENCES (Client / Supplier)

Name /
Address Contact number/s
Business Name

SPOUSE or CO-BORROWER INFORMATION

(Last Name, First Name, Middle Name, Suffix)
Full Name
Date & Place of (MM/DD/YYYY) (City/Municipality) Gender (Male or Female)
Birth
Present Length of Stay
Address ____ year/s ____month/s
Permanent Length of Stay
Address ____ year/s ____month/s
Provincial Length of Stay
Address ____ year/s ____month/s
Primary Phone Number Mobile Number E-mail Address/es
Contact Details
Citizenship or Filipino Others If “Others”, please specify:
Nationality
TIN / SSS / GSIS TIN _____________ SSS No. ______________ GSIS No. _____________
Number __________________
School Last School Name: __________________________________________
Attended / Year Grade/Level/College course: _________ Year Graduated (last year of stay):_____
Graduated
Owned (Not mortgaged) Rented: If “Rented”– (PHP/month) ____________
Owned (Mortgaged) If “Mortgaged” – (PHP/month) _________________
House Used Free
Ownership • If “Rented”, from whom? Individual/Bank/Company): ____________________
• If “Mortgaged”, from whom? (Individual/Bank/Company): _________________
• If “Free”, owned by whom? (Individual/Bank/Company): __________________
Owned (Not mortgaged) Rented: If “Rented”– (PHP/month) ____________
House Owned (Mortgaged) If “Mortgaged” – (PHP/month) _________________
Ownership in Used Free
Provincial • If “Rented”, from whom? Individual/Bank/Company): ____________________
Address • If “Mortgaged”, from whom? (Individual/Bank/Company): _________________
• If “Free”, owned by whom? (Individual/Bank/Company): __________________
Name of Employer: Name of Business: Not Applicable:
Name of
Employer /
Tenure of employment:
Business Monthly Income:
____ year/s ____month/s
Business Tel. No.
Employer /
Business
Address

BORROWER’S BANK ACCOUNTS

DATE ACCOUNT
BANK / TYPE
ACCOUNT NAME OPENED ACCOUNT NUMBER
BRANCH (SAVINGS/
(MM/DD/YYYY) CURRENT)
LANDBANK MARIA GINA DELLOMES 1995 SAVINGS
BPI MARIA GINA DELLOMES 2018 CURRENT
BDO MARIA GINA DELLOMES DECEMBER 2023 SAVINGS

GDFI Loan Application Form – April 2024

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BORROWER’S AUTHORIZATION TO VERIFY BANK DETAILS

To: ______________________
(Bank / Branch)

In compliance with Section 2 of Republic Act No. 1405, “AN ACT PROHIBITING DISCLOSURE OF OR
INQUIRY INTO, DEPOSITS WITH ANY BANKING INSTITUTION AND PROVIDING PENALTY
THEREFOR.” Otherwise stated, consider this as my written permission in favor of GLOBAL DOMINION
FINANCING, INC. (GDFI), or its authorized representative, to verify my savings/checking account with
your bank.

You are allowed to disclose the date of opening of my/our/savings/checking account and the Average
Daily Balance (ADB) for the last six (6) months from the date of this loan application.

ACCOUNT
NAME OF BANK/S / ACCOUNT TYPE
BRANCH
BRANCH NUMBER (SAVINGS /
CURRENT)

Thank you very much for your kind assistance.

MARIA GINA P. DELLOMES 05/18/2024

_____________________________________ ____________________________________
Borrower Spouse / Co-Borrower
(Signature over printed name / Date) (Signature over printed name / Date)

SPECIMEN SIGNATURES
Name of Borrower Name of Spouse / Co-Borrower
MARIA GINA P. DELLOMES

1. 1.

2. 2.

3. 3.

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BORROWER AND SPOUSE’S / CO-BORROWER’S UNDERTAKING

I/We hereby certify that all the information furnished in this Loan Application Form (LAF) is true, correct,
and complete. I/We further certify that the signatures affixed herein are true and genuine.

I/We hereby authorize GDFI to obtain such information, as may be required, concerning the validity and
veracity of the information provided in this application. I/We agree that this LAF, all supporting
documents and any other information obtained by GDFI relative to this application, shall remain as the
property of GDFI whether or not the loan is granted.

I/We consent to the forfeiture of the processing fee that I/we paid to GDFI in case I/we cancel, withdraw
or terminate my/our loan application without the fault of GDFI. I/We agree that any false statement or
concealment of information that may be discovered after the loan has been granted shall be sufficient
basis for GDFI to consider the loan as due and demandable.

GDFI branches DO NOT accept cash payments. Payments of any kind must be settled directly at GDFI-
accredited payment centers. Please refer to https://gdfi.com.ph for GDFI's list of accredited payment
centers.

We further understand that a cooling-off period of three (3) business days shall be applied following the
execution of this transaction. You may cancel this transaction without penalty; however, nothing herein
prevents GDFI from recovering the processing costs incurred.

That in case the present Loan Application will be granted by GDFI, I/We hereby consent to be contacted
before 6:00 A.M. or after 10:00 P.M., solely for collection purposes of the subject loan when past due
for more than fifteen (15) days.

MARIA GINA P. DELLOMES 05/18/2024

_____________________________________ ____________________________________
Borrower Spouse / Co-Borrower
(Signature over printed name / Date) (Signature over printed name / Date)

DATA PRIVACY CONSENT FORM

The privacy and security of your personal data (“Personal Information”) that GDFI collects is important
to us. It is equally important that you understand how GDFI handles this data. In conducting our
business, we must collect your “Personal Information”. It will be strictly used to administer your account
to provide the products and services you have requested from us and to further meet your needs and
the standard procedures of GDFI’s business.

We will treat your “Personal Information” as confidential data. It will only be disclosed, subject to our
permission, to GDFI’s affiliates and partners such as credit bureaus, collection companies, and other
financial institutions for the purpose of assisting you in your financial needs and for the effective handling
of your account.

For the proper assessment of your loan application, you hereby allow GDFI directly or through its
partners, to collect, retrieve, process, use, and store your “Personal Information” such as name, age,
photographs, mobile number/s, employment details, income, financial data, financial profile, credit
standing, loan payment history, other means of positive identification such as photograph, signature,
and/or such other identifiable features, and other information required in the application form for the
purpose of reviewing and processing your loan application.

For the list of GDFI’s Affiliates and Partners, please go to this link: https://gdfi.com.ph/partners-and-
affiliates/

Or scan this code:

Further, you hereby give consent to the collection of your personal data from telecommunication
companies, banks, credit bureaus, payment platforms, airlines, utility companies, suppliers, and
employers for credit evaluation purposes. Furthermore, in case of restructuring your loan obligation, you
are giving consent and allowing GDFI to disclose and collect information from the above-mentioned
institutions and people. Throughout the processing of your “Personal Information”, your rights under the

GDFI Loan Application Form – April 2024

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Data Privacy Act of 2012, such as the (1) right to be informed, (2) right to object, (3) right to access, (4)
right to rectification, (5) right to erasure or blocking, and (6) right to damages, shall be upheld. For your
complete rights as a data subject, please visit https://www.privacy.gov.ph/data-privacy-act/

For further information regarding GDFI’s privacy policy, you may visit our website at www.gdfi.com.ph.

All personal information collected will be stored in a secured location; and retained in accordance with
GDFI’s retention policies; and only authorized employees will have access to them.

If you think that your personal data was mishandled in terms of confidentiality or integrity, or if someone
tampered with your personal data without your consent, please do not hesitate to contact our Data
Protection Officer through the following:

Data Protection Officer

Unit 201 Jollibee Plaza Condominium,
Emerald Ave., Ortigas, Pasig City
Mobile Number: (63) 917 826 2931
E-mail Address: [email protected]

MARIA GINA P. DELLOMES 05/18/2024

_____________________________________ ____________________________________
Borrower Spouse / Co-Borrower
(Signature over printed name / Date) (Signature over printed name / Date)

FOR GDFI USE ONLY:

I certify that by exercising due diligence:

- I have verified the information stated in this LAF against the documents submitted by the
Borrower to be true and correct;
- I have collected all the required Know-Your-Client requirements from the Borrower and shall
proceed with the loan application process in compliance with GDFI’s existing policies as of the
loan application date; and
- In case the original document of the Borrower is not available for verification, I will ensure that
these are presented for verification prior to the release of the loan proceeds.

_________________________________ _________________________________
Verified by: GDFI Officer / Associate Checked by: Branch Head
(Signature over printed name / Employee No. / Date) (Signature over printed name / Employee No. / Date)

- Nothing follows -

GDFI Loan Application Form – April 2024