Installment Sales Application Form
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1July 2016
INSTALLMENT SALES APPLICATION FORM
Buyer’s Information Sheet
Date of Application : ______________________________________________________________________
Referred By Branch/Department : ___________________________________________________________
Endorsed by : ____________________________________________________________________________
Contact Number(s)/Local : _________________________________________________________________
Picture
Mobile Number: __________________________________________________________________________
Email Address: ___________________________________________________________________________
DESCRIPTION OF THE VEHICLE SUBJECT OF SALE
CS NO. / PLATE NO.
MAKE
TYPE OF TRANSMISSION
MILEAGE
Purchase Price of Vehicle
Term Applied for
(Maximum of 5 years
Installment Sales)
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YEAR MODEL
SERIES / VARIANCE
FUEL
COLOR
BUYER’S GENERAL INFORMATION
SPOUSE’S GENERAL INFORMATION
Name of Buyer (Last Name, Given Name, Middle Name)
Name of Spouse (Last Name, Given Name, Middle Name)
Nationality
Age
Nationality of Spouse
Age
Present Address (Number, Street Name, Barangay, City, ZIP Code)
Present Address (Number, Street Name, Barangay, City, ZIP Code)
Present Address (Owned, Rented, Mortgaged?)
Contact Number of Spouse
Permanent Address (Number, Street Name, Barangay, City, ZIP Code)
Present Employer of Spouse
Civil Status (Single, Married, Widow, Separated)
Address of Spouse’s Present Employer
Personal Email Address
Personal Email Address of Spouse
Date of Birth
Gender (Male, Female)
Name of Dependent
Age
SSS/Passport/Driver’s License Number
TIN
1.
Home Landline / Fax Number
Mobile Number
2.
Educational Attainment
3.
OCCUPATION / EMPLOYMENT
CHARACTER REFERENCES
Present Employer
Name/Relationship
Contact Number
Business Name (if self-employed)
1.
Employer’s / Business Address
2.
Position
Length of Stay
3.
Office Email Address
Office Landline
4 .
BUYER’S INCOME DETAILS
SPOUSE’S INCOME DETAILS
Monthly Income of Buyer
Monthly Income of Spouse
BUYER’S EXISTING LOANS AND CREDIT CARDS
SPOUSE’S EXISTING LOANS AND CREDIT CARDS
Name of Credit Cards/
Approved Loan Amount/
Outstanding
Name of Credit Cards/
Approved Loan Amount/
Outstanding
Banks
Credit Card Limit
Balance
Banks
Credit Card Limit
Balance
BUYER’S DEPOSITORY BANKS
SPOUSE’S DEPOSITORY BANKS
Bank / Branch
Account Name / Account
Date Opened /
Bank / Branch
Account Name / Account
Date Opened/
Balance
Number
Balance
Number
CERTIFICATE OF ACCURACY
I do hereby attest to the accuracy of the information stated above. Any misrepresentation may result in the termination of the Installment Sales
Agreement and immediate payment of the outstanding installment, at the sole option of Standard Insurance Co. Inc.
I authorize Standard Insurance Co. Inc. and its representative/s to obtain such information, to verify our/my bank accounts, credit accommodation
and balances, trade/business dealings, as it may require concerning this application.
________________________________________
_________________________________________
Signature of Buyer
Signature of Spouse
Note: Please fill up all required information. Write “N/A” if not applicable.
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Parent category: Financial