Escolar Documentos
Profissional Documentos
Cultura Documentos
2
(As amended by Circular No. 742 dated 21 November 2011 and Circular No. 794 dated 18 April 2013)
Application for1
Approval
Nature of Business
Postal Address
Website
Nature of Business
Postal Address
Website
Parent Company
Stockholder
PROFILE (Annex A.1)
1
None
Others (specify)
Nature of Business
Postal Address
Website
:
:
:
:
:
Parent Company
Stockholder
Foreign
Name
None
Others (Specify)
:
Nature of Business
Postal Address
Website
:
:
:
:
:
Parent Company
Stockholder
None
Others (Specify)
Page 2 of 5
Page 3 of 5
Page 4 of 5
(continued)
I hereby certify that (i) all representations made and documents/information submitted herein
are
trueand
and(ii) all copies of documents submitted (other than originals) are certified true copies of t
correct
(Designation)
Page 5 of 5
ANNEX A
BORROWER PROFILE
1. GOVERNMENT REGISTRATION(S)/AUTHORITY(IES)/FRANCHISE (Indicate original and amendments)
Government Agency/Authority
Securities and Exchange Commission
Reg. No.
Date
Validity Period
Par Value
Total Amount
Peso Value
Percent Share
Others (Specify)
2. CURRENT CAPITALIZATION
As of (ddmmyy)
No. of Shares
Authorized
Common
Preferred
Subscribed
Common
Preferred
Paid - up
Common
Preferred
CURRENT OWNERSHIP STRUCTUR As of (ddmmyy)
Name and Nationality*
No. of Shares
Filipino
Sub-total
Foreign
Sub-total
Grand Total
* If more than 10, indicate major stockholders only and aggregate the rest by nationality
Note: Indicate N/A if not applicable
Page 1 of 3
ANNEX A
BORROWER PROFILE
3. CURRENT PRINCIPAL OFFICERS/BOARD OF DIRECTORS (Indicate with an asterisk) AS O
Name
Position
Nationality
Latest Unaudited
As of (ddmmyy)
:
:
:
:
In Original Currency
Currency
Amount
USD Equivalent
Short-term
Offshore sources
FCDUs
Medium/Long-term
Offshore sources
FCDUs
Total
Page 2 of 3
ANNEX A
Page 2 of 3
ANNEX A
BORROWER PROFILE
4. FINANCIAL POSITION (in 000 functional currency) continued
Without BSP Approval/
Registration
Short-term
Offshore sources
In Original Currency
Currency
Amount
USD Equivalent
FCDUs
Medium/Long-term
Offshore sources
FCDUs
Total
Exchange rate assumption:
5. OTHER INFORMATION (such as disclosure of planned or actual changes in/status of capitalization, etc.
Short-term - those with original maturity of up to 1 year from initial disbursement date
Medium/Long term - those with original maturity of more than 1 year from initial disbursement date
Page 3 of 3
ANNEX A.1
CREDITOR PROFILE
1. GOVERNMENT REGISTRATIONS (Indicate original and amendments)
Government Agency/Authority
2. CURRENT CAPITALIZATION
+
Reg. No.
Date
Validity Period
As of (ddmmyy)
Currency
Amount
Authorized
Paid - up
CURRENT OWNERSHIP STRUCTURE
Nationality*
As of (ddmmyy)
Percent Share to Total
Grand total
3. CURRENT PRINCIPAL OFFICERS/BOARD OF DIRECTORS (Indicate with an asterisk) AS OF (ddmmyy):
Name
Position
* If more than 10, indicate major stockholders only and aggregate the rest by nationality
Note: Indicate N/A if not applicable
Nationality
ANNEX A.2
GUARANTOR PROFILE
1. GOVERNMENT REGISTRATIONS (Indicate original and amendments)
Government Agency/Authority
2. CURRENT CAPITALIZATION
Reg. No.
Date
Validity Period
As of (ddmmyy)
Currency
Amount
Authorized
Paid - up
CURRENT OWNERSHIP STRUCTURE
Nationality*
As of (ddmmyy)
Percent Share to Total
Grand total
3. CURRENT PRINCIPAL OFFICERS/BOARD OF DIRECTORS (Indicate with an asterisk) AS OF (ddmmyy):
Name
Position
* If more than 10, indicate major stockholders only and aggregate the rest by nationality
Note: Indicate N/A if not applicable
Nationality
ANNEX B
SUMMARY OF LOAN TERMS AND CONDITIONS*
Borrower
Currency of denomination
repayment
:
:
Lead Creditor
Country of Residence
Percent Share
Amount
TOTAL
* If used for Application for Registration of loans not subject to prior BSP approval, indicate specific sections of the covering
agreement for each loan term/condition.
** Possible entries: supplier's credit, revolving credit, bond/note issue, subordinated loan, etc.
Note: Indicate N/A if not applicable
Page 1 of 3
ANNEX B
SUMMARY OF LOAN TERMS AND CONDITIONS*
Project/Purpose (Annex C):
From:
To:
From:
To:
Grace Period :
Variable :
Rate:
Spread:
Other conditions (such as capitalization of interest, reduction or step-up in interest rate upon occurrence of certain events, int
subsidy):
First:
Last:
First:
Last:
Fees
Frequency of Payment
Periodic*
One-time (Flat)
Rate (In %) or
Amount
Basis for
Computation
Front-end Fee
Commitment Fee
Guarantee Fee
Insurance Premium
Agency Fee
Penalty/Default Rate
Prepayment
Premium
Others (specify)
Page 2 of 3
ANNEX B
SUMMARY OF LOAN TERMS AND CONDITIONS*
Guarantor/Insurer:
Percent Share
Name
Foreign
Local
TOTAL
Guarantee/Security/Collateral Terms, Conditions and Mechani
Other Financial Loan Terms and Conditions (such as additional costs and fees, taxation, minimum fin
ratios, cash waterfall, use of special accounts):
Page 3 of 3
ANNEX B.1
LOAN DISBURSEMENT AND AMORTIZATION SCHEDULES*
(In Original Currency)
Borrower
Creditor
Loan Amount
Currency
Maturity (in years)
Grace Period (in years)
:
:
:
:
:
:
Date** (ddmmyy)
:
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Principal Repayment
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Interest Payment
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Principal Balance
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TOTALS
ANNEX C
(If for refinancing/restructuring of existing obligations, indicate details using Annex C.1; If for relending, indicate beneficiary com
sector/s, relending terms including currency of relending and repayment)
Local Costs*
Orig. Currency
USD Equiv.
Foreign Costs**
Orig. Currency
USD Equiv.
Total
Orig. Currency
USD Equiv.
TOTALS
* Those payable to Philippine residents other than FCDUs
** Those payable to non-residents
Page 1 of 3
ANNEX C
Local*
Orig. Currency
USD Equiv.
Equity
Local investors
Foreign Investors
Total
Orig. Currency
USD Equiv.
Sub-total
Borrowings
Peso Borrowings
FX Borrowings
Sub-total
Costs to be Financed
Foreign**
Orig. Currency
USD Equiv.
Sub-total
Grand total
Page 2 of 3
ANNEX C
Page 3 of 3
ANNEX C.1
LIST OF OUTSTANDING OBLIGATIONS TO BE REFINANCED/RESTRUCTURED
AS OF (ddmmyy)
Date of BSP
Approval/Reg.
No.
BSPDAN
Creditor
Date
Granted
Loan Amount
Original
Outstanding
Currenc
y
Loan Purpose
Orig.
Interest
Repayment
Rate Schedule/Due Date
ANNEX D
Disbursements*
Date
Amount
T
I
Local Costs**
Item/Description
Currency
Amount
I
O
N
Foreign Costs***
Item/Description
Currency
Amount
TOTALS
TOTALS
(In USD Equiv.)
* Please indicate dates of actual transactions
** Those payable to Philippine residents other than FCDUs (details in Part 2)
*** Those payable to non-residents (details in Part 3)
(If more space is needed, use a separate sheet of paper following the same format)
Page 1 of 3
(For Applications for Registration only)
ANNEX D
Item Description
No.
Date
Invoice/Billing**
Amount (In PHP)
US$ Equiv.
Official Receipt***
No.
Date
TOTALS
Page 2 of 3
(For Applications for Registration only)
ANNEX D
Country
Item Description
No.
Date
Invoice/Billing**
Amount (In Orig.
Currency
Currency)
Official Receipt***
US$ Equiv.
No.
Date
TOTALS
* Those payable to non-residents
** Please arrange chronologicaly.
*** In lieu of official receipts, supplier/beneficiary's original certification of receipt of payment may be submitted.
(If more space is needed, use a separate sheet of paper following the same format)
Page 3 of 3
(For Applications for Registration only)
ANNEX E
INFORMATION SHEET ON LOAN APPLIED FOR BSP REGISTRATION*
A. BASIC LOAN INFORMATION
Borrower
Creditor(s)/Lead Bank
BSP-DAN
Fixed
Floating - Base
Spread
:
:
B. LOAN STATUS
:
:
:
:
:
:
Amount
(In Orig. Currency)
Remarks
condonation, etc.)
0.00
Total Drawdowns
:
Less
:
Principal Repayments
:
Add Capitalized Interest, if any
(Indicate period covered)
Outstanding Balance
:
:
TOTALS
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Principal
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Interest**
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Other Fees/Charges
Amount
:
Type
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Total
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Interest Rate: