MVC.2022.

0
Rush Ref #: _______________________
Agency/Inhouse: _______________________
PHILIPPINE SAVINGS BANK
MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: VENUE: WAREHOUSE: PLATE NO.: CONDUCTION:

YEAR MODEL / BRAND MAKE: COLOR: FUEL TYPE: TRANSMISSION:

SERIAL NUMBER: ENGINE NUMBER: ODOMETER (R): ODOMETER (W): FUEL READING (W):

ENGINE COMPARTMENT
DESCRIPTION GOOD FAIR POOR NONE DESCRIPTION GOOD FAIR POOR NONE
RADIATOR FUSE BOX
RADIATOR CAP ALTERNATOR
RADIATOR RESERVOIR TANK ALTERNATOR BELT
RADIATOR FAN POWER STEERING BELT
AUXILLARY FAN AIRCON BELT
A/C CONDENSER SERPENTINE BELT
WASHER TANK DIPSTICK
ENGINE OIL FILLER CAP INJECTION PUMP
AIR CLEANER COVER BATTERY Brand: ____________________
BRAKE FLUID RESERVOIR CAP
BODY EXTERIOR
HEAD LIGHT (RIGHT) DOOR SIDE FRONT (RIGHT)
HEAD LIGHT (LEFT) DOOR SIDE FRONT (LEFT)
HEAD SIGNAL LIGHT (RIGHT) DOOR SIDE BACK (RIGHT)
HEAD SIGNAL LIGHT (LEFT) DOOR SIDE BACK (LEFT)
FOG LIGHT (RIGHT) DOOR SLIDING (RIGHT)
FOG LIGHT (LEFT) DOOR SLIDING (LEFT)
SIGNAL LIGHT SIDE MIRROR (RIGHT) DOOR BACK/TRUNK
SIGNAL LIGHT SIDE MIRROR (LEFT) F-RIGHT TIRE BRAND: _____________
TAIL LIGHT (RIGHT) WHEEL ( )MAGS ( )RIM
TAIL LIGHT (LEFT) F-LEFT TIRE BRAND: ______________
TAIL BREAK LIGHT (RIGHT) WHEEL ( )MAGS ( )RIM
TAIL BREAK LIGHT (LEFT) R-RIGHT TIRE BRAND: _____________
TAIL SIGNAL LIGHT (RIGHT) WHEEL ( )MAGS ( )RIM
TAIL SIGNAL LIGHT (LEFT) R-LEFT TIRE BRAND: ______________
TAIL REVERSE LIGHT RIGHT WHEEL ( )MAGS ( )RIM
TAIL REVERSE LIGHT LEFT CENTER CAP ( )pcs / HUB CAP ( )pcs
THIRD BREAK LIGHT TIRE VALVE CAP ( ) Pcs.
EMBLEM ( ) Pcs. SIDE MIRROR (RIGHT)
LTO ISSUED PLATES ( ) Pcs. SIDE MIRROR (LEFT)
RADIATOR GRILLE BACK MIRROR
FRONT BUMPER FRONT WIPER ( ) Pcs.
REAR BUMPER REAR WIPER ( ) Pcs.
FRONT WINDSHIELD FRONT SUSPENSION
REAR WINDSHIELD REAR SUSPENSION
SPOILER (BUILT-IN) ANTENNA
TRUNK COMPARTMENT
SPARE TIRE Brand: ______________ TRUNK BOARD COVER/MATTING
SPARE WHEEL ( )MAGS ( )RIM BASIC TOOLS ( ) Pcs. JACK ( )Hydr/pcs ( )Manual/pcs
SPARE TIRE COVER TIRE WRENCH ( ) Pcs. JACK HANDLE ( ) Pcs.
EWD ( ) Pcs. TOW BOLT ( ) Pcs.
BODY INTERIOR
AIRCON IGNITION KEY ( ) Pcs.
INSTRUMENT PANEL (ODO, Etc.) REMOTE ONLY ( ) Pcs.
AIRBAG ( ) Pcs. KEY w/ REMOTE ( ) Pcs.
STEERING WHEEL ( ) w/ controls DOOR KEY ONLY ( ) Pcs.
HORN DOMELIGHT ( ) Pcs.
SIGNAL LIGHT LEVER STEREO ( ) INFOTAINMENT
WIPER LEVER Brand: _____________________
WINDOW HANDLE ( ) Pcs. SPEAKER ( ) Pcs.
POWER WINDOW MAIN CONTROLS SEAT BELTS ( ) Pcs.
WINDOW CONTROL FRONT RIGHT HEAD REST ( ) Pcs.
WINDOW CONTROL BACK RIGHT SEAT FRONT RIGHT
WINDOW CONTROL BACK LEFT SEAT FRONT LEFT
REAR VIEW MIRROR SEAT BACK ROW
SUNVISORS ( ) Pcs. SEAT FIRST ROW (VAN TYPE)
GRAB HANDLE ( ) Pcs. SEAT SECOND ROW (VAN TYPE)
GLOVE COMPARTMENT SEAT THIRD ROW (VAN TYPE)
ARM REST COMPARTMENT SEAT FOURTH ROW (VAN TYPE)
DASH BOARD SEAT SIDE RIGHT (FB TYPE)
BACK BOARD SEAT SIDE LEFT (FB TYPE)
ACCESSORIES
SEAT COVER ( ) Pcs. RAIN GUARD ( ) Pcs.
FLOOR MATTING ( ) Pcs. GARNISH ( ) Pcs.
STEERING WHEEL COVER MANUAL BOOKLET
OTHER VEHICLE ITEMS NOT ON THE LIST (Qty / Description) PERSONAL BELONGINGS (Qty / Description)
1 4 1 4
2 5 2 5
3 6 3 6
DAMAGE/DEFECTS/REMARKS:

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: YEAR MODEL / BRAND MAKE: PLATE NO.: CONDUCTION:

REMARKS

DAMAGE REPORT

RIGHT HAND LEFT HAND

REAR REAR

RIGHT HAND LEFT HAND

FRONT FRONT

O DENTS ? MISSING
/ SCRATCHES X DAMAGE

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: YEAR MODEL / BRAND MAKE: PLATE NO.: CONDUCTION:

REMARKS

DAMAGE REPORT

RIGHT HAND LEFT HAND

REAR REAR

RIGHT HAND LEFT HAND

FRONT FRONT

O DENTS ? MISSING
/ SCRATCHES X DAMAGE

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: YEAR MODEL / BRAND MAKE: PLATE NO.: CONDUCTION:

REMARKS

DAMAGE REPORT

RIGHT HAND LEFT HAND

REAR REAR

RIGHT HAND LEFT HAND

FRONT FRONT

O DENTS ? MISSING
/ SCRATCHES X DAMAGE

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: YEAR MODEL / BRAND MAKE: PLATE NO.: CONDUCTION:

REMARKS

DAMAGE REPORT

RIGHT HAND LEFT HAND

REAR REAR

RIGHT HAND LEFT HAND

FRONT FRONT

O DENTS ? MISSING
/ SCRATCHES X DAMAGE

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: YEAR MODEL / BRAND MAKE: PLATE NO.: CONDUCTION:

REMARKS

DAMAGE REPORT

RIGHT HAND LEFT HAND

REAR REAR

RIGHT HAND LEFT HAND

FRONT FRONT

O DENTS ? MISSING
/ SCRATCHES X DAMAGE

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: YEAR MODEL / BRAND MAKE: PLATE NO.: CONDUCTION:

REMARKS

DAMAGE REPORT

RIGHT HAND LEFT HAND

REAR REAR

RIGHT HAND LEFT HAND

FRONT FRONT

O DENTS ? MISSING
/ SCRATCHES X DAMAGE

TO BE FILLED UP BY CLIENT/POSSESSOR TO BE FILLED-UP BY REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY

SURRENDERED BY: RECEIVED BY AND INVENTORIED BY:

________________________________________ _________________________________________________________
CLIENT/POSSESSOR REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME) ( SIGNATURE OVER PRINTED NAME/DATE & TIME)
TO BE FILLED UP BY BANK's WAREHOUSE PERSONNEL/GUARD ON DUTY
RECEIVED / CERTIFIED TRUE & CORRECT:

____________________________________________________________
BANK'S WAREHOUSE PERSONNEL/GUARD ON DUTY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)
 MVC.2022.0
Rush Ref #: _______________________
Agency: _______________________

PHILIPPINE SAVINGS BANK

MOTOR VEHICLE CHECKLIST
ACCOUNT NAME: ACCOUNT NUMBER:

UNIT DESCRIPTION: PLATE NUMBER / CONDUCTION STICKER:

SERIAL NUMBER: ENGINE / MOTOR NUMBER:

VEHICLE STENCIL

VALIDATED BY:

____________________________________________________________
REPOSSESSOR/DRIVER/BRANCH/EXTERNAL AGENCY
( SIGNATURE OVER PRINTED NAME/DATE & TIME)