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Attorney-In-Fact/Loan Administrators

Information Sheet

Name: ___________________________________________________________________________________ ____

Last Name First Name Middle Name

Address:

*Present Residence:__________________________________________________________________

Permanent Address: _____________________________ *Business/Ofce: __

______________________________________________________________________________________________

*Email Address: ___________________________________________________________________________

Nature o Wor/Business: ________________________________________________________

Name o Em!lo"er/Business: ______________________________________________

#ource o Funds :_________________ $%N/### No&/'#%# No:______________

(ontact Num)ers:

*Residence: __________________ Ofce:_________________ (ell !one: _________________ ____

*Fa+ No&: _____________________

Personal %normation:

,ate o Birt: ____________ Place o Birt:__ ________________________________A-e: _____ _______

#tatus: _____ _ ____________ #e+/'ender: ___ _____________ (iti.ensi!: _________ _ ______________

Relationsi! to Borroer/(o0)orroer/'rantor: _________________________________________________

#!ouse 1i an"2 : __ _________________________________________________________________________

Last Name First Name Middle Name

,ate o Birt: ____________ Place o Birt:__________________________________A-e: ____________

(iti.ensi!: ______________

Relationsi! to Borroer/(o0)orroer/'rantor: __________________

Reason or a!!ointment o Attorne"0%n0Fact/Loan Administrator: ___Borroer is an

OFW&_________________

#!ecimen #i-natures:

3&__________________

4&__________________5&__________________

%/We ere)" certi" tat te inormation contained erein is/are true and correct and tat %/We a6e

)een dul" a!!ointed as attorne"0in0act/loan administrator o te olloin-:

Borroer: ___________________________ _______________________________________________________

(o0)orroer: _______________________________________________________________________________

We urter irre6oca)l" autori.e Banco ,e Oro 7ni)an8 %nc& 1B,O2 to disclose to an" entit" an"/all

inormation !ro6ided erein as ma" )e re9uired )" rele6ant las or re-ulations&

_________________________________________ ____________

#i-nature o A%F/Loan Adm& o6er !rinted name

Afrmed )":

___________ ___________

#i-nature o Borroer/s o6er !rinted name