AUTHORITY TO REQUEST FOR DEPOSIT AND CREDIT ACCOUNT INFORMATION

TO WHOM IT MAY CONCERN:

This is to authorize RURAL BANK OF ANGELES (A Rural Bank) , thru its representative MELCHOR D.
CABIGTING to request for informations and conduct inquiries on my/our deposits, loan dealing(s) and such other
transactions with any Bank, Financial Institution, Trade Creditor, Government Agency and Private
Company/Corporation, relevant to my/our loan application/accomodation with the above mentioned Bank, thereby
waiving my/our rights under any existing laws, rules and regulations governing the secrecy and confidentiality of the
bank deposits, loan dealings and other like documents.
Issued this ______th day of ___, at _____________________________________, Pangasinan.

BY:

LEILA O. DAILEG
MABINI, MONCADA, TARLAC

CREDIT/LOAN ACCOUNT
Name of firm
Type of account
Amount of loan
Date granted
Date due
Interest Rate
Term of loan
Collateral/s
Amortization
Mode of payment
Account balance
Status/handling
Times of accomodation
Informant
Designation
 RURAL BANK OF LIMAY
National Road, Brgy. Townsite, Limay, Bataan

AUTHORITY TO REQUEST FOR DEPOSIT AND CREDIT ACCOUNT INFORMATION

TO WHOM IT MAY CONCERN:

This is to authorize RURAL BANK OF LIMAY (A Rural Bank) , thru its representative CI/Appraiser
____________________________________________ to request for informations and conduct inquiries on my/our deposits,
loan dealing(s) and such other transactions with any Bank, Financial Institution, Trade Creditor, Government Agency
and Private Company/Corporation, relevant to my/our loan application/accomodation with the above mentioned Bank,
thereby waiving my/our rights under any existing laws, rules and regulations governing the secrecy and confidentiality
of the bank deposits, loan dealings and other like documents.
Issued this ______th day of ____________________, at _____________________________________, Bataan.

BY:

LEILA O. DAILEG 0
Signature over printed name of Borrower Signature over printed name of Borrower

#REF! #REF!
Postal Address Postal Address

NON-CREDIT ACCOUNT ( C/A, ATA, S/A, TIME DEPOSIT & CHECKING ACCOUNT )
Name of bank
Account name
Type of account
Account number
ADB / Acct. bal.
Check issued/mo.
Highest amt. issued
How long
Status/handling
Informant
Designation

CREDIT/LOAN ACCOUNT
Name of firm
Type of account
Amount of loan
Date granted
Date due
Interest Rate
Term of loan
Collateral/s
Amortization
Mode of payment
Account balance
Status/handling
Times of accomodation
Informant
Designation

Prepared By:
MERVIN L. NATIVIDAD
CI/appraiser
ANK OF LIMAY
 (Consolidated GM BANK, INC. and BANGKO LUZON, INC.)
Brgy. Dimasalang, Maharlika Highway, Cabanatuan City

AUTHORITY TO REQUEST FOR DEPOSIT AND CREDIT ACCOUNT INFORMATION

TO WHOM IT MAY CONCERN:

This is to authorize GM BANK OF LUZON INC. (A Rural Bank) , thru its representative CI/Appraiser
______________________ _____________ to request for informations and conduct inquiries on my/our deposits, loan
dealing(s) and such other transactions with any Bank, Financial Institution, Trade Creditor, Government Agency and
Private Company/Corporation, relevant to my/our loan application/accomodation with the above mentioned Bank,
thereby waiving my/our rights under any existing laws, rules and regulations governing the secrecy and confidentiality of
the bank deposits, loan dealings and other like documents.
Issued this ______th day of _______________, at _____________________________________, Nueva Ecija.

BY:

LEILA O. DAILEG 0
Signature over printed name of Borrower Signature over printed name of Borrower

#REF! #REF!
Postal Address Postal Address

NON-CREDIT ACCOUNT ( C/A, ATA, S/A, TIME DEPOSIT & CHECKING ACCOUNT )
Name of bank
Account name
Type of account
Account number
ADB / Acct. bal.
Check issued/mo.
Highest amt. issued
How long
Status/handling
Informant
Designation

CREDIT/LOAN ACCOUNT
Name of firm
Type of account
Amount of loan
Date granted
Date due
Interest Rate
Term of loan
Collateral/s
Amortization
Mode of payment
Account balance
Status/handling
Times of accomodation
Informant
Designation

Prepared By:

CI/appraiser
 WAIVER OF RIGHTS

We, spouses GLORIA P. LOPEZ and CARLITO P. LOPEZ both of legal age, Filipinos and residents of
No.55-B Circumferential Road, Kapt. Pepe Subd., Cabanatuan City, Nueva Ecija, Philippines hereby DECLARE AND
MANIFEST the following to wit:

1. We would like to waive our rights under the Bank Secrecy Law (RA 1405), and hereby authorize any authorized
representative of GM Bank of Luzon Inc. to verify examine , and to do all other acts that are necessary to
verify/check our financial information recorded in the Bureau of Internal Revenue District Office

2. We hereby give our consent voluntarily, expressly and without any reservation. We also acknowledge that in
case there are negative findings in our financial information/records in the Bureau of Internal Revenue District
Office ___________________________, such information shall be used for us to be denied of our
loan/debt/restructuring application.

3. We also acknowledge the right of GM Bank of Luzon Inc. to use such information in such other matter that is
incidental or pursuant to our loan/debt/restructuring application.

LEILA O. DAILEG 0
NAME OF BORROWER NAME OF BORROWER

SIGNED IN THE PRESENCE OF :

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES) S.S.

BEFORE ME, A Notary Public, for and in the above stated locality, on this _____ day of ____________ 201_,
personally appeared:

NAME Government Issued ID’s ID TYPE/DATE/PLACE OF ISSUE

Known to me to be the same persons who executed the foregoing instrument and acknowledged to that the
same is their free and voluntary act and deed and that of the corporation/s they represent.

This instrument refers to Waiver of Rights consisting of One (1) page, including this page and signed by the
parties and their instrumental witness on all pages.

IN WITNESS WHEREOF, I have hereunto set my hand and seal on the date and at the place first above written.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series 2012
 (Consolidated GM BANK, INC. and BANGKO LUZON, INC.)
Brgy. Dimasalang, Maharlika Highway, Cabanatuan City

AUTHORITY TO REQUEST FOR DEPOSIT AND CREDIT ACCOUNT INFORMATION

TO WHOM IT MAY CONCERN:

This is to authorize GM BANK OF LUZON INC. (A Rural Bank) , thru its representative CI/Appraiser
________________________________________ to request for informations and conduct inquiries on my/our deposits,
loan dealing(s) and such other transactions with any Bank, Financial Institution, Trade Creditor, Government Agency
and Private Company/Corporation, relevant to my/our loan application/accomodation with the above mentioned
Bank, thereby waiving my/our rights under any existing laws, rules and regulations governing the secrecy and
confidentiality of the bank deposits, loan dealings and other like documents.
Issued this ______th day of _____________, at _____________________________________, Nueva Ecija.

BY:

Signature over printed name of Borrower Signature over printed name of Borrower

Postal Address Postal Address

NON-CREDIT ACCOUNT ( C/A, ATA, S/A, TIME DEPOSIT & CHECKING ACCOUNT )
Name of bank
Account name
Type of account
Account number
ADB / Acct. bal.
Check issued/mo.
Highest amt. issued
How long
Status/handling
Informant
Designation

CREDIT/LOAN ACCOUNT
Name of firm
Type of account
Amount of loan
Date granted
Date due
Interest Rate
Term of loan
Collateral/s
Amortization
Mode of payment
Account balance
Status/handling
Times of accomodation
Informant
Designation

Prepared By:

CI/appraiser
 (Consolidated GM BANK, INC. and BANGKO LUZON, INC.)
Brgy. Dimasalang, Maharlika Highway, Cabanatuan City

AUTHORITY TO REQUEST FOR TRIAL COURT INFORMATION/RECORDS

TO WHOM IT MAY CONCERN:

This is to authorize GM BANK OF LUZON INC. (A Rural Bank) , thru its representative CI/Appraiser
MERVIN L. NATIVIDAD to request for informations and conduct inquiries on my/our Municipal/City Trial Court
Records, relevant to my/our loan application/accomodation with the above mentioned Bank, thereby waiving my/our
rights under any existing laws, rules and regulations governing the secrecy and confidentiality of the trial court
records and other like documents.
Issued this ____ day of _____________ 20__ at __________________________________________________.

BY:

LEILA O. DAILEG
Signature over printed name of Borrower Signature over printed name of Borrower

#REF! #REF!
Postal Address Postal Address

Prepared By:
MERVIN L. NATIVIDAD
CI / Appraiser