Appendix 16

\FORMAT OF DISCLOSURE STATEMENT ON SMALL BUSINESS/RETAIL/CONSUMER CREDIT(Appendix to Sec. 306 on Information to be Disclosed)

____________________________________
(Business Name of Creditor)

DISCLOSURE STATEMENT ON LOAN/CREDIT TRANSACTION
(As Required under R.A. No. 3765, Truth in Lending Act)

NAME OF BORROWER _____________________________________
ADDRESS_________________________________________________

1. LOAN AMOUNT P XXX
2. OTHER BANK CHARGES/DEDUCTIONS COLLECTED1 P XXX
a. Documentary/Science Stamps P __________
b. Mandatory Credit Insurance    __________
c. Others (Specify)    __________
3. NET PROCEEDS OF LOAN (Item 1 less Items 2 and 3) P XXX
4. SCHEDULE OF PAYMENTS
a. Single payment due on date P XXX
b. Installment Payments (Please see attached amortization schedule)
5. EFFECTIVE INTEREST RATE (Interest and Other Charges) XXX%
Explanation: The effective interest rate is higher than the contractual interest rate of % because of Item 2 deductions above.
6. CONDITIONAL CHARGES THAT MAY BE IMPOSED (if applicable). Please specify manner of imposition:
a. Late Charge P __________
b. Prepayment (penalty/refund)    __________
c. Others (Specify)    __________
  ___________________    __________
CERTIFIED CORRECT:
________________________________________
(Signature of Creditor/Authorized
Representative Over Printed Name)
________________________________________
Position

I ACKNOWLEDGE RECEIPT OF A COPY OF THIS STATEMENT PRIOR TO THE CONSUMMATION OF THE CREDIT TRANSACTION

________________________________________
(Signature of Borrower over
Printed Name)
________________________________________
Date

__________________________________________________________________________
AMORTIZATION SCHEDULE
(Sample Only)

Installment (A) Loan (B) Principal (C) Interest (D) Total (E) O/SBalance (F)
 xxx xxx
1  xxx  xxx xxx  xxx
 2  xxx  xxx  xxx  xxx
 3  xxx  xxx  xxx  xxx
 4  xxx  xxx  xxx  xxx
 5  xxx  xxx  xxx  xxx
 6  xxx  xxx  xxx  xxx
 7  xxx  xxx  xxx  xxx
 8  xxx  xxx  xxx  xxx
 9  xxx  xxx  xxx  xxx
 10  xxx  xxx  xxx  xxx
 11  xxx  xxx  xxx  xxx
 12  xxx  xxx  xxx  xxx
 Total  xxx xxx  xxx

Legends:

A – Number of installment periods based on loan term
B – Gross amount of loan
C – Installment payment on the principal
D – Installment payment on the interest
E – Total amortization payment for the installment period
F – Outstanding principal balance of the loan

Footnotes

  1. Notes
    Itemize all charges including advance deductions
    – Small business/Retail/Consumer Loans includes microfinance, auto (motor), salary, personal, medical, educational and other loans of similar nature
    – This document contains the minimum information required to be disclosed to the borrower and may be enhanced to improve client information