Republic of the Philippines

Department of Education
Provident Fund
Date Submitted: Loan Application No.
Loan Amount: PhP Purpose:
□ Educational
Type of Loan: Term: year/s □ Hospitalization/Medical
□ Multi-purpose □ Long Medication/Rehabilitation
□ New □ House Arrears/Equity
□ Renewal □ House Repair - Major
□ Additional □ House Repair - Minor
□ Payment of Loans from Private insti tution
□ Calamity
□ Others (specify): _____________________________
Borrower’s Information Co-Maker’s Information
_______________________________________________ _______________________________________________
(Surname) (First Name) (M.l.) (Surname) (First Name) (M.l.)
Home Address: ______________________________________ Home Address: ______________________________________
________________________________________________ ________________________________________________
Position: ___________________________________________ Position: ___________________________________________
Employee No.: ___________ Employment Status: _________ Employee No.: ____________ Employment Status: ________
Office: _____________________________________________ Office: _____________________________________________
Date of Birth: ____________________ Age: ______________ Date of Birth: ____________________ Age: ______________
Monthly Salary: PhP ____________ Office tel. no. ________ Monthly Salary: PhP ____________ Office tel. no. ________
Years in Service: _______ Mobile no. __________________ Years in Service: _______ Mobile no. __________________
DepEd E-mail address: _________________________________
Specimen Signatures: Specimen Signatures:

_____________________ ___________________ _____________________ ___________________

LOAN AGREEMENT
I hereby a pply for a Provi dent Fund Loa n i n the a mount of PESOS: I hereby a gree to assume all the outstanding obligations for the grant
______________________________________ (P ___________). In of thi s l oan s hould the pri ncipal borrower be s eparated from the
cons ideration of the grant thereof, I promise to pay all installments due s ervi ce, a nd either retirement or s eparation benefits due to him/her is
ba s ed on the a ttached a mortization schedule and bind mys elf with the not received or i s insufficient to settle the borrower's outstanding loan,
terms a nd condi tions of the l oan a s s ti pulated i n the a pplicable a nd upon proper notification by the Provident Fund Secretariat.
gui delines of the DepEd Provi dent Fund. This document a lso s erves as
the Promi ssory Note upon a pproval of this loan. Accordi ngly, I hereby a uthorize the monthly deduction from my salary
of the a morti zations for the outs tanding obl igation of the principal
Accordi ngly, I hereby a uthorize the deductions of the monthly borrower until his/her l oan i s fully paid.
a morti zation from my s a lary. Should I be s eparated from the service, I
a l so hereby a gree to settle my outstanding loan balance before the date
of my reti rement/separation from the s ervi ce, either through full
pa yment i n ca sh or through the execution of a notarized Promissory
Note.

___________________________________ ________________ ___________________________________ ________________

Signature of Borrower Date Signature of Co-Maker Date
over Printed Name over Printed Name

CERTIFICATE OF EMPLOYMENT AND CREDIBILITY

Personnel Division/Unit: Legal Service/Unit:

Thi s Is to certify that the above l oan a pplicant/borrower: Thi s is to certify that the above loan applicant/borrower has no pending
(1) i s a ___ permanent/___co-terminus employee of this Office a dministrative nor ci vil case charge a gainst him/her based on records
a nd is not on leave of a bsence without pay; on fi l e with DepEd.
(2) ha s net pay of PhP ______________ for the payroll month &
yea r of ______________________; a nd
(3) ha s given the true and correct i nformation on the Loan
Appl ication Form.

MARIA DIVINA H. CALLEJA JINKY BATALLA-NOCOS

___________________________________
Administrative Officer IV . Attorney III
___________________________________ .

Signature over Printed Name Signature over Printed Name

Designation: ____________________________ Designation: ____________________________
Date: Date:
Authorization for Salary Deduction
I hereby a uthorize the deduction of __________________________________________________________________ PESOS
(P ____________) from my s a lary for ______ months, starting in ___________________, 20___ to
__________________, 20__ or unti l my total outstanding l oan of ___________________________________________PESOS
(P______________) ha s been fully paid. Amount deducted shall be credited to the account of the DepEd Provident Fund a s
recei vables on the said l oans.

___________________________________
Borrower’s Signature over Pri nted Name
Empl oyee No. _____________________ Sta tus: ____________ Des ignation: ______________________
Di vi sion: ____________________________ Code: ____________ Servi ce: __________________________
 SECRETARIAT’S ASSESSMENT/EVALUATION
A. Documents Submitted:
□ Loan Application Form (LAF) □ Additional documents for Additional Loan:
□ Authority to Deduct □ Letter request
□ 3 LATEST pay slip (ORIGINAL) □ Hospitalization/Medical Expenses
□ Photocopy of DepEd ID – Borrower and Co-maker □ Medical Abstract/Certificate/Prescription/Diagnosis
□ Approved Appointment (for FIRST TIME borrowers and □ Barangay/LGU certificate/resolution declaring
Co-terminus employees only) the borrower’s place under State of Calamity
□ Document showing proof that the co-terminus employee has rendered
At least 2 years service in DepEd, e.g. Notarized Contract of Service
□ Others (specify): ________________________________ Revi ewed by: Da te:
_____________________________________________
B. Completeness and Veracity of Submitted Documents:
□ Signed and completely filled out LAF
□ Complete supporting documents, for type of loan applied for
□ Signatures on LAF are by authorized signatories Revi ewed by: Da te:

C. Eligibility of the Borrower and Co-Maker

□ Borrower will not reach the mandatory age retirement on or before the maturity of his/her loan. Age:
□ Co-Maker will not reach the mandatory age retirement on or before the maturity of his/her loan. Age:
□ Borrower has Outstanding PF Loan Balance:
□ Current Loan Balance Amount: PhP
□ Past-Due Loans Amount: PhP
□ No. of Years/Months Past-Due: Year/s: Month/s:
□ Borrower's Net Take-Home Pay after deduction of monthly amortization of the loan being applied for
is equal to or higher than the required threshold for the current year.
□ For renewal of loans: Borrower has paid at least 30% of the principal of the existing loan.
Percentage of principal paid: % Veri fied by: Da te:

D. Computation of Loan:
Principal Amount of Loan PhP _______________ Net Take Home Pay after Deduction PhP _____________
Less: Outstanding Balance of Loan to be Renewed Monthly Amortization PhP______________
Principal PhP _______________ Period of Loan (mm/yy - mm/yy) ______________
Interest _______________ _______________
Net Proceeds PhP _______________ Date Processed: _________________________

Processed by:
MELISSA F. PARAFINA
Senior Bookkeeper
_____________________________ Remarks:
Si gnature over Pri nted Name ____________________________________________________________
(PF Secretariat) ____________________________________________________________
____________________________________________________________
Reviewed by: _____________________________ ______________________________________________________
Si gnature over Pri nted Nam e _____________________________________________________
(Head, PF Secretariat) ______________________________________________________

ACTION TAKEN:

Recommending Approval:
□ Approved
□ Disapproved
GINA A. VALENCIANO
Administrative Officer V .

Head, PF Secretariat
Signature over Printed Name
NORMA B. SAMANTELA, CESO VI
Da te: ___________________ Schools Division Superintendent .

Head, PF Secretariat
Signature over Printed Name
Da te: ___________________