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C i t i Personal Loan Appl icat ion FormCode . - Agen tcode

e Dqadv ired that Citibanh Savings will rend you nlormatton regarding your application an4 your

/ a t t a c h t h e f o i o v ii n q r e qu i re m e nt s :( I f em p l oye d 1 . L a te s t i n co m e T a x R e tu r n ( iT R ) /W Z

.La test 1 month 's pays l ip

.Two va l id pho to bear inq gover nmen t i ssued IDS:O n e P r i m a r y ID ( cu r ren t d r i ve r ' s license. SSS. TI No r va l i d p a ssp o r t )

.Last 2 m o n th s c r e d i t ca r d s t a te m e n t of a cco u n t( I f se l f - e m pl o ye d ) A d d i t i on a l f i na n c i a l s t a te m e n ts w i t h b a n k s ta m pL a s t 2 m o n th s b a n ks ta te m e n ts

8 evi-to- a n CUI orneri w no persona a a n w I i an avlnqs: Fiipino or nan-Filipino reildent foreigners: Phiiippine residents only

Add reri Requirement : Metro Manila, Metro Cebu, Metro Davaoand all iacationrwhere Ciiibanh Savinqr Loan Centers are presentTelephone Availability : Must have a rer idenceandlar bur inerr phone

J A p p a n r e l i u m # ! u r e J T r a i i i J C a r Pv r ih ase l Repa r3 i u t o n Fee Paywent 3 KeC8caiExpenrer JDebt Canial8dation

U Loan amount applied far 1 Maximum Loan amount allowed 3 Willing l o submit

My preferred manner of release of loan proceeds ir via:3 Credit to my Bank Account number: p~1 8 0 0 Cash Dirburrai:3 Deliver Manager's Check

IautharizeCitibank Savings todeliver my msnager'schech to the biilinqaddrerl9perifiedin Box It39 if i am not able to pirh-up my rhech within 48 hours from date 01 approval.

Customer's Signature

Middie . . . . .~-

a" riqninq on this application form, i authorizecitibanksavings todoa credit the? m a l l my creditcards and urt data available during the evaluation of my ci ti Persona! Loanapp1,tat~on.

CONTACT NUMBERS 910-5270 TO 75

TELEFAX 910-5271

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Only lorTradeReferences

(Only for Self-employed)Your Personal Reference: You must haveat le ast2 trade rcferencesand 1 reference who is an accountant.

Total Arre ts P

IMPORTANT SECTION :Please fill o u t t o c o m p i et e t h e f o r m

RelativeFriend

Co-Employee

As stated in th e Banqko Sentral nq Pilipinas [BSPI Circular 622, you are required tosubmit a coo vol "our latest IncomeTax Return (ITR). if aoolicable, dulv stamoed asrete ,ed 5 i ' . i e ~ l , e a c a ' nrerna ne.en:e 0 R . r re pi i r x n e r r r i 013. cD c n,a* ar00:ler reg. sons i ,o . aree>qdqe? n P _ I ?PSI , o r i r e req. rro 13 ,.o" !a (OF, ~1jc .r alest ' r m c d ~ ld le me , .~ s .~ )~ * l l~o lo rl d ~ d lon P.IPOIPI'O!P=8'7

NAME

if youa re relf.employed, you MUST attest:O I certify that I am the owner of a business, wherein its total ar re tr less thevalu e

of the land on which my bur lne rr' dfic e, p lant and equipmentare situated is[please check onel:O up to P3 miilion3 more than P3 milli on.up to P15 million';I greater than PI5 million

If you receive purely compensation income fmm a single employer durinq the calendaryear, you MUST attest:

ADDRESS

O I certify that Iam qualified under the rubr titu ted fil ing of ITR; tha t SIR Form1604CFflled by my empioyer rhall cons titutea s my 1TR;andthat W2 rhall servear a subst itute for my ITR.

PHONE NO.

if you are not deriving salary, compensation or income from any burinerr, trade.pmfe~sionor other activities, you must attest:O I certify that I am not dcrivlnq salary. compensation or income fmm any business,trade, proferrion or other activities which require me under Philippine tarlawrlrequlation to file any ITR, or be subject to the issuance of any cer tificateof compensation paymentltax withheld ar a rubrtitvle to such ITR. I

Customer'$ SignatureNOTE.We will ppmcess your application only if you submit the complete set of requireddocuments.

.. ..my *atemen's of arcodnlr ar o a ot t er r0mm.n ca: on n C:lned on n '.I r,CI P e r m s .~an to my 3 ng aao'err

Products and Services IOn arcar on. C I o a n l SaPnyr IC S ma, worm mp aoa.! :r 2rOmo. cn a o'ferr1110~onm? @.ma fax ShlS 0' ovl* P P ~ O ~ PCS ma, a ro a 3h Is sf' ales raenrran 0 I C D I P S ~ ~ ! ~ !. P I B ~ O ' - r l 3,r' $5 ,SC: ( PC 3 , 0' , t i I'em.-3 e r i a n : o n l a n e %to off& specially selected products and service; to he throu gh m a i i l e - m a i l l f a ~ l ~ ~ ~or bv telephone. For thi r Puroore. CS1 mav transfer and disclose selected curta mer

for thh purposes indicated above and undei apbllcabie laws and requldtionr

Pleasedo not enclose payment. If your application i r approved, the documentary stamp tax andDrocessinq fee will be deducted horn the approved loan amount.I Pro~eslinqFee / 4%0f Loan Am0~ntorP2.500whichever is applicable II Documentary Stamp P1.00lor every P2OO Approved Loan Amount or fraction thereof 1

Interest lntererton theCiti Personal Loanshail beinaccordance with the PromissoryNote and Oisclorure Statement governing thir Cf ti Personal Loan

1 Late Payment Fee 8% of amount due per month or P500 per month whichever ir hiqher 11 Bounced Check Fee P1.000.00 IBy siqnlnq below:

i hereby apply for a Citi Personal Loan. I warrant and aqree that all copies ofdocuments enclosed are true and remain the property of Citibank Savings (CSI).I warrant that ail inform ation given in this Application Form are true and correct andauthor ize CS1 to in vestia ate the inform ation fro m whatever sources CSI mav considerappropriate. I authorize CSI to obta in and disclose inform ation about m e from andto any affiliate of CSI, any reference source, any credit reportinq agency or anysubsidiary, or third pa rty, for purpose of evaluatinq this application form, for creditreport inq, verification, and other risk manaqement requirements. Iauthorize CSI toconduct random verification with the BIR in order to establish the authen ticity of myiatest Income Tax Return (ITR) and other accompanying financial statements sub mittedby me to CSI. i aqree that this constitutes m y writ te n consent for any transfer anddisclosure of info rmati on relating to my application for Citi Personal Loan. I confirmand acknowledae that I shall hold CSI free and harmless from anv liabilitv th at m avarise from obtaining, transfer, disclosure or storaqe of such information rel atinq tomy application. i understand that CSI may, at i ts sole discret ion, deny m y loanapplicat ion with no obligat ion on its par t to advise me of such denial or furnish thereason thereof. I aqree that th e final term sand con diti ons of any loan to be qrantedby CSI shall be aqreed upon after cre dit inves tiqation and approval of this application.Upon such approval. CSi shall require me to submit suc h other documents as m ay berequir edfor the qm ntinq of a loan, includinq but not limited to,copies of my certificateof employm ent, valid identification cards, income tax retur ns duly stamped as receivedby th e BIR, amonq others. i aqree that i f approved, the documentary stamp tax,proces sinqfee and such other fees as may be charged by CSI in connection with theloan shall be for m y account.

I aqree that mail inq of t he manaqer's check, statements of account and othernotices shall be to th e address soecified bv me in Box# 39 unless CSI encountersdifficult ies in the deliveries t o the specified address.

iaqr ee that by receipt of the proceeds of my Citi Personal Loan either throuqh thereceipt, encashm ent or deposit ot th e manaqer's check or by electronic trans fer offunds or any other specific means and failure to return such proceeds to CSi withinone (1) bankinq day from such receipt, I confirm th at I received the correct am ountcorrespondinq to the proceeds of my Citi Personal Loan.i aqree that if the manaqer's check is for delivery, receipt of the manaqer's checkby my authorized representative at my C iti Personal Loan billinq address, who presentsan authoriza tion letter sioned bv mvself and oresents a valid ID, shail be deemed to. . .be receipt by m e of the manaqer's check personally.i aqree that any electronic transfer of funds shall be subject to the rules andregulations of the receiving bank specified by me.

In the event of fut ure delinauencv. I herebv authorize CSI to reoor t and/or include, ..my name in the neqative listinq of any credit bureau or institution.

1 ' Siqnature of Applicant over Printed Name Date SiqnedSignature of Sllouse Date Siqned

8 Date Rece ived:

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Avail of Loan Protect Plus and give yourselfand your loved ones peace of mind.Get maximum protection by insurinq your Citi Personal Loan up to 5 timesits amount.in case of death or permanen t disablement, your family and loved oneswill receive a sum of monev that can be used to cover health-related costs.

mortqaqe payments. t~ tlon or oiher expenses to cover the r var1o.s neeasP IS, yoJr lam y need no! wor- aoout ,o.r oan s nce Loan Prol ec l Plus wpay for theoutsta ndins balance on the principal amount. . . .

For a minimal one-time upfr ont premium, your family's fut ure i s secure ifand when somethinq happens to you. The single premium includes all applicabletaxes.

Sample Singe Premium"costs per Loan Amount at 24 months

**Final insurance premium depends on your aqe bracket and loan amount.0:When does my Loan Protect Pius coverage start and what w ill the duration o fthe coverage be?A: Your Loan Protect Pus coveraue starts on the day that vour loan is approved.

I I I . I z, o e s e r l r ,q.r o nqaoorca 3t'er 3.2 i i i . 5' c I . r . 7 . , co :?,ereo 1nro.qno.l rneen: -2c.r.: ..I?:vour loan . Your Loan Protect Plus coveraoe will terminate when vou refinanceyour ioan. However, the unearned premiums wili be appiied to t he new accountand wiil reflect as payment to the loan.

O: How do i pay for the insurance premiums?A: Your insurance premium wii l beau tomatic ally deducted fro m your loanproceeds. This is a one-time uplront payment.O: Will I qet a refund if Idecide to pre- termn ate my ioan?A: Yes. The unearned premium will be arefunded to you. However, the amou nt

will be minimal because it will be based on the Pre- Termination scheduledefined by the Insurance Company.Your premium refund will be appiied to th e principal loan outstanding balanceat t he t imevou pre- terminatevour oan.To ensure tha t vour re fund isproperly applied, you must adv ise your Relationship ~a n a g e rpr io r t opie-terminating the account.

Loan Protect Plus ir optional

Secure your family's future. Enroll in Loan Protect Plusand insure your Ci ti Personal Loanup to 5 times it s amount.a I want to be covered under Loan Protect Plus that will pay for the tot al

outstanding principal balance of my loan in case of death or permanent disablement.Any amount o f benefit in excess of the tot al outstandinq principal balance shallbe paid to th e insured in case of permanent disablement, or t o the beneficiaryliesin accordance with th e Certificate of Coveraqe in caseof death.

i declare that I am between age 21 t o 58 years old, in qood health and havenot been hospitalized nor treated for any illnessin the past 12 months. Iunderstandthat no benefit for death or permanent disablement wili be payable where theevent qivinq rise to a claim is caused by an illness which occurred 12 months priorto th e effecti ve date of my insurance. Iagree to be bound by all other ter ms andconditions of the C ertificate of Coveraue to be issued by Pru Life insuranceCorporation of UK (Pru Life UK).

Iauthorize Citibank Savinqs (CSII to deduct the premium charqes fro m thelaan oroceeds for remittance t o C itlcoro Financial Services and Insurance BrokeraaePhils., Inc. (CFSI).

Iauthorize CSI and CFSI to provide any relevant information on me/ o r myloan account with CSI to Pru Life UK for purposes of Loan Protect Plus.

Loan Protect Plus Coveraqe5 x loan amount Z x loanamount4 x loan amount equal to loan amount3 x loan amount

Siqnature el Applicant Over PrintedName Date Signed

IMPORTANT

of Coveraqe,

Ci t i never s leeps

c s b a n k savings