Date: ________________________
Request for Statement/Certification and Authorization to Debit
This is to request for the following statement/s and certification/s for my ___housing ___auto loan account under
Loan
Account Number (LAN) _______________________________ for the ff. purpose: _____________________
Statement of Account to Fully Pay P 300 1-2 days
Computation of the amount needed to be paid to settle loan in full
Certificate of Full Payment P 300 1-2 days
Certification that loan has already been fully paid and closed
Certificate of Balance P 300 1-2 days
Certification of loan details, including due date, loan term and collateral description
History of Payment P 300 1-2 days
Statement indicating all previous loan payments and application to principal
Amortization Schedule P 300 1-2 days
Statement indicating future amortizations due and application to interest and principal
OR/ CR Certification P 300 2-3 days
Certification of original Official Receipt and Certificate of Registration in the Bank’s custody (auto loans only)
Certified True Copy of TCT/CCT P 300 2-3 days
Certified true copy of the original title in the Bank’s custody (housing loans only)
Certified True Copy of Loan Documents P 300 2-3 days
Certified true copy of any loan-related documents including mortgage loan agreement, etc.
Certificate of Interest Paid P300 2-3 days
Certification indicating interest paid and outstanding principal balance for a specific period, used for BIR reporting
purposes. Please specify required period __________________________
History of Application of Payment P 300 4-5 days
Detailed statement indicating all previous payments and application to interest, principal and other fees
Others, please specify __________________________
Preferred Mode of Delivery:
For pick-up at ___________________________
Free
Send to my e-mail address
E-mail address ______________________________________________________
Free
Deliver to the nearest BPI branch
Preferred BPI branch _________________________________________________
P100
Deliver to my mailing address
Mailing address _____________________________________________________
P100
This is also to authorize the Bank to debit the corresponding processing fee and delivery fee from:
my enrolled ADA account
BPI Savings / Current Account # ____________________________
_________________________________________ (Signature
over Printed Name)
Borrower/Authorized Representative
Contact Number/s:_________________________________
Note: Attach copy of valid ID
For bank’s use:
Signature verified by:
_________________________
(Signature over Printed Name)
