tcm adc accreditation form
DESCRIPTION
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SC INNOVA
ADC ACCREDITATION FORM
S&M-FRM004-00-20100930
Application NumberDate
PERSONAL INFORMATIONAPPLICANTFamily NameFirst NameMiddle Name
HOME ADDRESS ZIP CODE
No., Street, Barangay/Barrio, Municipality/City, Province
PRESENT BUSINESS ADDRESSZIP CODE
No., Street, Barangay/Barrio, Municipality/City, Province
TEL NOCIVIL STATUS MarriedSEX MaleAGETIN
SPOUSEFamily NameFirst NameMiddle Name
BUSINESS DATA/INCOMEAre you employed? YES NOAre you engaged in a business? YES NOOccupation
EMPLOYMENT DATA (APPLICANT)
Present Employer
Contact Person
Address
Telephone Number
Present Position
Employment Status
Years of StaySalary
EMPLOYMENT DATA (SPOUSE)
Present Employer
Contact Person
Address
Telephone Number
Present PositionEmployment StatusYears of StaySalary
BUSINESS DATA
Business Name FMP Marketing
Telephone NumberYears of Operation
Nature of Business
Average IncomeBank Account Number
PERSONAL REFENCES (at least three)NAMEPOSITIONCOMPANYRESIDENCE ADDRESSTEL NO
RESIDENCE ADDRESS SKETCH
BUSINESS ADDRESS SKETCH
I hereby certify that all information given are true and correct to the best of my knowledge and belief. I authorize UNISTAR CREDIT AND FINANCE CORPORATION through its authorized representative to conduct verification of information given and may cancel or disapprove my application on the ground of misrepresentation of information.
Should this application be denied, UNISTAR CREDIT AND FINANCE CORPORATION is under no obligation to furnish the results of its investigation.
CONDRAD E. VIOLA PRINT NAME AND SIGNATURE OF APPLICANT Endorsed by: _______________________ DATE__Ricky L. De Vera Branch Manager/Area ManagerBACKGROUND INVESTIGATION YES NO1) Is the subject known to the resource person? 2) How long have you known the subject? 1-6 mos. 7-12 mos. 1 yr
3) Does the family of the subject known to the resource person?
4) Is the subject known for any bad record in the community?
a. Involvement in crime or social offense?
b. If yes, nature of crime or offense ______________________________
5) Is the subject known for any vices, like gambling, drinking, use of illegal drugs?
6) If the subject is married, how many children does he/she have? 1-3 4-6 7-above
7) If the subject is married, is the spouse working?
a. If yes, nature of spouse job and company name
____________________________________________________________
8) Does the subject own the house where he/she lives?
9) Does the subject rent the house where he/she lives?
a. If yes, how much is the rent? 1K-3K 4K-6K 7K-10K
10) Does the subject own the place where the ADC is located?
a. If not, indicate the name of the owner __________________________
11) Will you recommend the subject to be one of the accredited Authorized Display
Center Agent?
a. If no, please state reason/s ___________________________________
RESOURCE PERSON/S:
Name: Address & Contact Numbers
1) ____________________________ ____________________________________________2) ____________________________ ____________________________________________
Evaluated by:
_________________________
Credit Specialist
Noted by:
_________________________
Financing Manager