MKMJ STORE

Brgy. Baybay
Municipality of Sulat, Eastern Samar
Tin # 111-367-575
PERMIT # 16-092

APPLICATION FOR LOAN

APPLICANT CO-MAKER
____________________________________________
____________________________________________
Last Name First Name MiddleLast Name First Name Middle
Name Name

____________________________________________
____________________________________________
Home Address Home Address

____________________ ____________________
Contact Number Contact Number

____________________________________________
____________________________________________
Employer Employer

____________________________________________
____________________________________________
Work Address Work Address

_______/____/____ _________ _______/____/____ _________

Date of Birth Age Date of Birth Age

_______________________ _______________________
Signature over Printed Name Signature over Printed Name

APPLICANTS AGREEMENT

I hereby certify apply for a LOAN: the type, amount, and the applicable amortization schedule below.

REASON FOR LOAN AMOUNT OF LOAN AMORTIZATION

SCHEDULE

EMERGENCY CASH LOAN _______________________________ Bi-monthly for Amount =

___________
SALARY LOAN In words Monthly for Amount =
___________
BARANGYA LOAN ____________
OTHERS In numbers One-time payment
of_______________ on
Date ________________

In consideration of the grant thereof. I promise to pay all the amortizations, due and bind myself,
together with my co-maker, to the terms and conditions of loan as printed at the back accordingly. Also,
I promise to use this amount only for the purpose stated above.

Written promissory note of applicant (include the source and date of payment):

_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

Furthermore, my co-maker assumes responsibility for the payment of the loan in case of my inability to
do so.