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___________________________________________________
Business
Name of Creditor
DISCLOSURE
STATEMENT OF LOAN/CREDIT TRANSACTION
(SINGLE
PAYMENT OR INSTALLMENT PLAN)
Name of Borrower _____________________
Address __________________________
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1.
Cash/Purchase price ___________________ or Net Proceeds of Loan (Item
Purchased)
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_____________
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_____________ |
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2.
Less: Downpayment and /or
Trade-in Value (Not applicable for loan transaction) |
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_____________ |
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3.
Unpaid Balance of Cash/Purchased Price or Net Proceeds of Loan
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4. Non-Finance Charges [Advanced by
Seller/Creditor]:
a.
Insurance Premium
b.
Taxes
c.
Registration Fees
d.
Documentary/Science Stamps
e.
Notarial Fees
f.
Others:
____________________
____________________
____________________
Total
Non-Finance Charges
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P ___________
___________
___________
___________
___________
___________
___________
___________
___________
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_____________
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5. Amount to be Financed (Items 3/4)
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6. Finance Charges
a.
Interest _______% p.a. from ________ to _______
[
] Simple
[ ] Monthly
[
] Compound
[ ] Quarterly
[ ] Semi-Annual
[ ] Annual
b.
Discounts
c.
Service /Handling Charges
d.
Collection Charges
e.
Credit Investigation Fees
f.
Appraisal Fees
g.
Attorney’s/Legal Fees
h.
Other charges incidental to the extension of credit
(specify):
__________________
__________________
__________________
Total Finance Charges
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P ___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
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P ____________ |
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7.
Percentage of Finance Charges to Total Amount Financed
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_________ % |
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8. Effective Interest Rate
(Method
of computation attached)
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_________% |
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9. Payment
a.
Single Payment due __________
(Date)
b.
Total Installment Payments
(Payable
in ______________ weeks/moths @
(No. of Payments)
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P ___________ )
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P ___________
P ____________
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10.Additional
Charges in case certain stipulations in the contract are not met by the
debtor:
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Nature
__________________
__________________
__________________
__________________
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Rate
__________________
__________________
__________________
__________________
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Amount
__________________
__________________
__________________
__________________
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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 and that I understand and fully agree to
the terms and conditions thereof:
________________________
(Signature of Buyer/Borrower
Over Printed Name)
Date ____________________
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