RHED Financing Application Form 1

APPLICATION FORM
2” x 2” Colored ID
LOAN INFORMATION
Picture (Attach/
glue/paste here)
Loan Amount: __________________ Term: __________________

Purpose of Loan
Purchase of Fixed Assets
Working Capital or Equipment
Acquisition of Property
for Business Business Expansion
Construction or Renovation Please add information or
specify other purposes
APPLICANT's INFORMATION
Name: ________________________________________________________________________________________________________________
FIRST NAME MIDDLE NAME LAST NAME
Birthdate: _______________________ Birthplace: _______________________ Gender: Male Female

(mm/dd/yy)
Highest Educational Attainment: _________________________
Citizenship: ___________________
Permanent Address: ________________________________________________________________________________

Present Address: ________________________________________________________________________________
Email Address: ___________________________________ Contact No/s .: _________________________________
SSS/GSIS No.: _______________ TIN: _________________
BUSINESS INFORMATION
Name of Business: _______________________________________________________ Years in Operation: __________
TIN: _________________________________ SSS: ________________________________
Business Address: Contact No: Owned Length of Stay:

_____________________________________________________________ __________________ Rented ______________
Factory/Branch Address: Contact No: Owned Length of Stay:

_____________________________________________________________ ____________________ Rented ______________
Nature of Business: ____________________________ Type of Business: Partnership Corporation Sole
SPOUSE's INFORMATION
Name: ____________________________________________________ SSS/GSIS No.: _______________ TIN: _________________

First Middle Last
Birthdate: _______________________ Birthplace: _______________________ Gender: Male Female

(mm/dd/yy)
Citizenship: ___________________ Contact No.: __________________ Highest Educational Attainment: _________________________
TRADE REFERENCES
Major Customers Contact Person/Position Contact No.
Major Suppliers Contact Person/Position Contact No.
Relatives / Friends Contact Person/Position Contact No.
BANK/s INFORMATION
Bank Branch Account Number Account Name Date Opened (mm/dd/yy)

AUTHORIZATION AND UNDERTAKING
As the loan applicant, you affirm that all information provided in this application form are true and correct, and all supporting documents submitted
directly to Esquire Financing Inc. and HRRA or its official sales channels are legitimate, genuine and legally obtained from the issuing government
agencies/private entities. Any incorrect or misleading information and misrepresentation will result to disapproval of the application. In case of
disapproval, Esquire Financing Inc. and HRRA are under no obligation to disclose the reason/s for such disapproval. In furtherance of your application,
you hereby give consent to the following circumstances: (1) Entrance and inspection of your residence, main/principal place of business and operations
facility/ies by duly authorized representatives of Esquire Financing Inc. and HRRA as part of its credit evaluation and in order to validate all the
information disclosed by you in this Application Form and in any supporting documents submitted by you to Esquire Financing Inc. and HRRA;
(2)Verification of any information provided herein and in any supporting documents hereto with any applicable banks, credit bureaus, private or
government agencies and other institutions, as may be indicated in this application form, or with any entities/individuals you have additionally indicated in
this application form; (3) Release or disclosure of any relevant information by such holder, controller, and processor of the information to confirm, release
and verify the existence, truthfulness, and/or accuracy of any information provided to Esquire Financing Inc. and HRRA (4) Processing of your
information under the Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes, and disclose any and all information as required by
relevant authorities; and (5) Receipt by you from Esquire Financing Inc. and HRRA, its affiliates, and third-party vendors or partners of Short Messaging
Services (SMS), mobile and/or email alerts/messages for the purpose of confirming your application and its status. You hereby expressly waive any and
all statutory and regulatory provisions governing confidentiality of client information with respect to any information you entered in this Application Form
and in any supporting documents hereto insofar as it is necessary to disclose appropriate information to verify such other information provided in this
Application Form and in any supporting documents hereto. You hereby agree to indemnify and hold Esquire Financing Inc. and HRRA, its affiliates,
officers, directors, employees, consultants, contractors, agents and representatives free and harmless from any and all third party claims, losses, liability,
damages and costs arising from any liabilities that may arise due to inaccurate representation of any information indicated herein.
____________________________________________________
Signature of Applicant over Printed Name
DOCUMENTARY REQUIREMENTS
Kindly submit the following : BASIC

REQUIREMENTS Additional requirements for specific type of
- Fully filled out application form business: Sole Proprietorship

- TIN ID and one (1) valid government - DTI Certificate of business name registration
issued ID of the principal borrower
- Latest three (3) months bank statements Partnership
and bank certification - Business TIN ID proof (BIR Certificate of
- Photocopy of valid Mayor’s Permit Registration)
- Photocopy of valid Barangay Business - SEC Certificate of Incorporation/Registration
Clearance - Latest Articles of Partnership & By-Laws
- 2x2 ID picture of the principal borrower - Partner’s Resolution (EFI prescribed format:
- Proof of billing for business and residence Version PR.10.2017)
- Pictures of the business (internal and external) Corporation
- Hand drawn sketch map of business and
residence - Business TIN ID proof (BIR Certificate of
Registration)
- SEC Certificate of Incorporation/Registration
- Latest Articles of Incorporation & By-Laws
- Latest General Information Sheet (GIS)
- Secretary’s Certificate (EFI prescribed
format: Version
SC.20.2017

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APPLICATION FORM

Loan Amount: Term:

Birthdate: _ Birthplace: _ Gender: Male Female

Permanent Address: ________________________________________________________________________________

SSS/GSIS No.: _ TIN: ___

Business Address: Contact No: Owned Length of Stay:

Factory/Branch Address: Contact No: Owned Length of Stay:

Nature of Business: ____________________________ Type of Business: Partnership Corporation Sole

Name: ____________________________________________ SSS/GSIS No.: _ TIN: ___________

Birthdate: _ Birthplace: _ Gender: Male Female

Major Suppliers Contact Person/Position Contact No.

Relatives / Friends Contact Person/Position Contact No.

Bank Branch Account Number Account Name Date Opened (mm/dd/yy)

Kindly submit the following : BASIC

- Fully filled out application form business: Sole Proprietorship

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