Date:

Mr.
Officer-In-Charge
Department of Loans and Credit
Bangko Sentral ng Pilipinas
A. Mabini Corner P. Ocampo, Sr. Streets
1004 Malate, Manila

Dear Sir:

I would like to apply for full cash settlement of the past due loan of
____________________with the closed Rural Bank of Santiago (Agusan del Norte),
Inc. under the provisions of Monetary Board Resolution (MBR) No. 1366 dated
18 September 200A, as amended by MBR No. 165 dated 12 February 200B. The
details of my loan are as follows:
Name of Borrower :
Original Amount of Loan : ₱10,000.00
Date Granted : 20 February 1976
Date Due : 20 February 1977
Outstanding Balance as of : 25 July 2017 Amount:
Collateral : TD No. 2726
You may contact me at telephone no. _______________________ and at my
postal address:

Taxpayer Identification No.:

Thank you.

Very truly yours,

_________________________