ACEF APPLICATION Form

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CLASS D

Attach 1 x 1
photo of
borrower/
signatory

APPLICATION FORM
Land Bank of the Philippines (LBP)
Address and Telephone/Fax Numbers of
___________________________________
the Lending Center
(Name of Lending Center)

A. Applicant (Aplikante)/Business Profile (Profile ng Kumpanya)


Applicant/Business Name (Pangalan ng Aplikante/Kumpanya) Tax Identification Number (If available)
- - -

Applicant/Business Address (Address ng Aplikante/Kumpanya) Contact No/s. Contact Person/s

Applicant Type (pls. check “”)


Individual Cooperative/Farmers Org./Assn. Financial Institution/MFI
Farmer Multi-Purpose Cooperative Countryside Financial Institution
Fisher Credit Cooperative Microfinance Institution (MFI)
Agrarian Reform Beneficiary ARB Cooperative/Association Others (pls. specify)
Micro and Small Enterprises Farmer’s Organization/Association
Others (Pls. Specify) Others (pls. specify)
Nature of Business (Uri ng Negosyo) Number of years in business
(Ilang taon sa Negosyo)
Registered with (Rehistrado sa) (pls. check “”, if applicable) Registration Number Date of Registration
SEC DTI CDA Others (Pls. specify)

For Individual Borrower (Para sa Indibidwal na Humihiram)


Farmer’s Tenurial Status (pls. check “”)
Land Owner Lease Holder Farm Area (Sukat ng Lupang sinasaka)
(May ari ng lupa) (Nangungupahan) ___________________ hectares

B. Credit Requirement (Halaga ng Hihiramin)


Type of Facilities Purpose (Paggagamitan)
Proposed Tenor/Maturity
(Uri ng Utang) Amount (Halaga)
(Pls. check “”)
(Panahon ng Pagbabayad) (Pls. check “”)
Short Term loan/line _______ days P Working Capital
Term Loan _______ years P Acquisition of ________________
Others, pls. specify P Construction of _______________
Others _______________________

C. Project/Commodity to be Financed (Klase ng Proyekto na Popondohan)


Agricultural Production (pls. specify) Fixed Asset Acquisition/Construction Working Capital (pls. specify)
(pls. specify)

D. List of Board of Directors and Key Officers (if applicable)


Name of Officer Position

Loan Application Form


CLASS D

Agreement/Kasunduan

I/We affirm that each of the statement made in this application is true and correct and agree to notify
LBP of any material change affecting the information contained herein. I/We authorize LBP to obtain and verify
such information as may be required covering this application from the above references or any other sources.
I/We agree that all information obtained by LBP shall remain its property whether or not the loan is granted.

Pinapatunayan ko/namin na lahat ng pahayag na ginawa sa aplikasyon na ito ay totoo at tama at


sumasang-ayon na ipapaalam sa LBP ang anumang material na pagbabago na makaka apekto sa mga
impormasyon na nakalahad dito. Pinapayagan ko/namin ang LBP na makakuha at mapatunayan ang nasabing
impormasyong kung kinakailangan para sa aplikasyon na ito mula sa mga nabanggit na impormasyon o galing
sa ibang pagkukunan. Ako/Kami ay pumapayag na lahat ng impormasyon na makuha ni LBP ay mananatili na
kanilang pag-aari, ma aprubahan man o hindi ang aking/aming aplikasyon.

________________________________________ ________________________________________
Signature Over Printed Name of Authorized Signatory Signature Over Printed Name of Authorized
Date Signed: _______________ Signatory
Date Signed: _______________

Received by:

________________________________________
Signature Over Printed Name of Account Officer
Date Received ____________________

Loan Application Form Page 2 of 2

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