Republic of the Philippines -p,, ; \

DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula

New Renewal _____________ Loan Application No.________

Type of Loan ( ) Regular ( ) Special ___________Education_____ Hospitalization/Medical
__________ House Arrears_____ Major House Repair
__________ Payment of Loan from Private Institution
__________ Others (Pis. Specify)_________________

BORROWER'S INFORMATION CO-MAKER'S INFORMATION:

(Last Name) (First Name) (M.I.) (Last Name) (First Name) (M.I.)
Home Address: Home Address:
Date of Birth: Date of Birth:
Position: Position:
Division/Office: Division/Office: Finance
Monthly Salary: Civil Status: Monthly Salary: Civil Status:
No. of Years in Service: No. of Leave Credits: No. of Years in Service: No. of Leave Credits:
Specimen Signatures (2 below) Specimen Signatures (2 below)

APPLICATION AGREEMENT
I hereby apply for a Provident Fund Loan in the amount and Should the Principal borrower be separated from the service and
at the amortization schedule stated below. In consideration there are no retirement nor separation benefits due him/her, I
of the grant hereof, I promise to pay all the installment due hereby agree to assume all his/her outstanding obligations for the
and bind myself to the terms and conditions of the loan. grant of the loan upon proper notification by the Provident Fund
Accordingly, I hereby authorized the deduction of the monthly Secretariat. Accordingly, hereby authorize the deductions from my
amortization from my salary when due. Should I be separated monthly salary the amortizations for the outstanding obligation of
from the service, I also hereby agree to settle my outstanding the principal borrower until his/her loan has been fully paid.
loan balance before the date of the retirement/separation
from the service, either through full payment in cash or
issuance of a duly notarized promissory note.

Signature of Borrower Date Co- Maker's Signature Date

Over Printed Name Over Printed Name
Employee No. Employee No.

AMORTIZATION SCHEDULE

Amount of Loan (12 months) (24 months) (36 months) (48 months) (60 months)

( ) P 5,000.00 430.34 221.61

( ) P 10,000.00 860.67 443.21
( ) P 20,000.00 886.42 608.44 469.71 386.66
( ) P 30,000.00 1,329.62 912.66 704.56 579.99
( ) P 50,000.00 2,216.04 1,521.10 1,174.26 966.65
( ) P 100,000.00 8,606.65 4,432.07 3,042.20 2,348.51 1,933.29

Pls encircle preferred amortization schedule (subject to computation o f monthly net take home pay

AMORTIZATION FOR SALARY DEDUCTION

The HRMO, Personnel Division

DepEd ROIX, Pagadian City

I hereby authorize the deduction from my salary the amount of _________________________________________________

fo r ______months starting in ,_______ , on or until my total amount of _________________________________________________
( ) has been paid. Amount deducted shall be credited to the amount of DepEd Provident Fund amortization on said loan.

(Signature of Borrower over Printed Name)

Employee Number Division

Designation Pos. Service/Center/Bureau
Status
 CERTIFICATE OF EMPLOYMENT AND CREDIBILITY

Office Date

This office certifies that (1) the above application is a / / permanent / / casual employee of this Office and
is not on leave of absence without pay; (2) there is no pending administrative charge against him/her(3) the net
pay of the borrower indicated is sufficient to cover monthly installement of this loan; and (4) the information
reported by said applicant is true and correct.

For Casual Employees:

No. of Years in Service_____________
No. of Leave Credits

INDORSING OFFICIALS

PERSONNEL DIVISION LEGAL DIVISION

(Name in Print) (Name in Print)

(Designation) (Designation)

FOR SECRETARIAT USE ONLY:

Documents Submitted
( ) Payslip ( ) Statement of Official Receipts ( ) Official Receipts/Doctor's
( ) Photocopyof Payroll/Payslip of Tuition Fees Prescription
( ) Statement of House Arrears ( ) Bill of Materials for House Repair ( ) Approved appointment
( ) Others: ______________

Computation of Loan:

Amount of Loan Applied for ____________________ Amount of Monthly Amortization

Balance of Previous Loan ____________________ Amortization Schedule

Net Proceeds

Signature of Secretariat

ACTION TAKEN:

( ) Approved ( ) Disapproved

CRISOLOGO SINGSON ISABELITA M. BORRES, CESO III

Office of the Chief Administrative Officer Office of the Regional Director

Head of Secretariat Chairman

Approved/Disapproved of special loan by Board Chairman upon the recommendation of the Secretariat.