Consent Form - For Credit Verification

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CONSENT AND AUTHORIZATION

I, ______[NAME OF BORROWER]_________________, Filipino citizen, of legal, age, with postal


address at ______[borrower’s address]__________________hereby give consent to, and authorize the
Personal Information Controller (PIC) or Personal Information Processor (PIP) of my personal information,
or any person holding or processing my personal information relating to my:

1. residencestatus at ______[complete residential address of borrower]__


__________________________ (including but not limited to my length of stay, whether I owned
the place or otherwise, etc.];
2. employment status at __________[name of company employer’s trade
name]_____________________ (including but not limited to my status as
permanent/contractual/project employee, length of employment, job title rank, etc.)

to disclose and provide to the PHILIPPINE SAVINGS BANK (PSBANK), and/or its authorized
employee and/or service provider tasked to do credit verification any personal information or document
containing my personal information relating to the above, for the purpose of validation and verification of
the information Isubmitted to PSBANK in connection with my loan application therewith.

I further give consent to and authorize PSBANK to receive from the said PIC/PIP/holder/processor any
personal information or document related to the above, and to use and process the same for the
aforementioned purpose.

In giving the above authorities, I hereby hold the said PIC/PIP/holder/processor of my personal
information, as well as PSBANK, its directors, officers, employees, and agents, free and harmless from,
waive, and indemnify the latter against, any and all claims, suits, proceedings, actions, and other demands
related to data privacyin connection with the disclosure, receipt, use, and processing of my personal
information.

I hereby warrant that this Consent and Authorization was voluntarily and willfully executed knowing the
full legal consequences thereof, and for the purpose of my loan application with PSBANK.

Signed this _____[Date] _______ in ________[Place], by:

_________________________________
[printed name of Borrower]

Witnessed by:

______________________________
[signature above printed name]

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