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1. Form Title and Date: Clear identification of the document as an Authorization to Release Loan Information Form with date of execution
2. Authorizing Party Information: Complete details of the person authorizing the release of information, including full legal name, address, contact information, and valid government ID numbers
3. Lender Information: Details of the financial institution that holds the loan information, including complete business name and address
4. Recipient Information: Complete details of the person or entity authorized to receive the loan information
5. Scope of Authorization: Specific description of what loan information may be released, including account numbers and types of information
6. Purpose of Disclosure: Clear statement of the purpose for which the information is being released
7. Duration of Authorization: Specific period for which the authorization is valid
8. Data Privacy Notice: Statement regarding data privacy rights under RA 10173 and consent to process personal information
9. Authorization Statement: Clear declaration of consent to release information and waiver of applicable confidentiality rights
10. Signature Block: Space for authorizing party's signature, date, and witness signatures if required
1. Joint Account Holder Authorization: Additional authorization section when the loan account has multiple holders
2. Attorney-in-Fact Authorization: Section to be included when authorization is being given through a legal representative
3. Special Instructions: Any specific instructions regarding the method or timing of information release
4. Revocation Clause: Optional section detailing the process for revoking the authorization before its expiration
5. Foreign Language Translation: Parallel text in another language if the authorizing party is more comfortable in a language other than English
1. Schedule A - Specific Loan Accounts: Detailed list of specific loan accounts covered by the authorization
2. Schedule B - Authorized Information Types: Itemized list of specific types of loan information authorized for release
3. Appendix 1 - Valid ID Requirements: List of acceptable forms of identification for verification purposes
4. Appendix 2 - Supporting Documents: List of any required supporting documents that must accompany the authorization form
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