Nine hundred sixty six & 64/100

966.64 60 JULY 2024

JUNE 2029 FIFTY THOUSAND PESOS
###

Nine hundred sixty six & 64/100

966.64 60 JULY 2024

JUNE 2029 FIFTY THOUSAND PESOS

###

Nine hundred sixty six & 64/100

966.64 60 JULY 2024

JUNE 2029
FIFTY THOUSAND PESOS
###
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF EDUCATION
Provident Fund
Date Submitted: Loan Application No.
Loan Amount: Purpose:
Educational
Type of Loan: Hospitalization/Medical
Multi-purpose Long Medication/Rehabilitation
New House Arrears/Equity
Renewal House Repair - Major
Additional House Repair - Minor
Payment of Loans form PLI's
Term: Calamity
Others (specify):

BORROWER'S INFORMATION CO-MAKER'S INFORMATION

(Surname) (First Name) (M.I) (Surname) (First Name) (M.I.)

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: __________________________________ Deped E-mail address: __________________________________
Specimen Signatures: Specimen Signatures:
________________________ _____________________ ____________________ ______________________

LOAN AGREEMENT
I hereby apply for a Provident Fund Loan in the amount of PESOS: I hereby agree to assume all the outstanding obligations for the
____________________________________ (P _________________). In grant of this loan should the principal borrower be separated from
consideration of the grant thereof,I promise to pa yall installments due the service, and either retirement or separation benefits due to
based on the attached amortization schedule and bind myself with the him/her is not received ir is insufficient to settle the borrower's
terms and conditions of the loan as stipulated in the applicable guide- outstanding loan, and upon proper notification by the Provident
lines of the DepEd Provident Fund. This document also serves as the Fund Secretariat.
Promissory Note upon approval of this loan.
Accordingly, I hereby authorize the monthly deduction from my
Accordingly, I hereby authorize the deductions of the monthly salary of the amortizations from the outstanding obligation of the
amortization from my salary. Should I be separated from the service, I principal borrower until his/her loan is fully paid.
also hereby agree to settle my outstanding loan balance before the dat
of my retirement/separation from the service, either through full
payment in cash or through the execution of a notarized Promissory
Note.
_______________________________________ _______________ ____________________________________ _____________
Signature of Borrower over Printed Name Date Signature of Co-Maker over Printed Name Date
CERTIFICATE OF EMPLOYMENT AND CREDIBILITY
Personnel Division/Unit: Legal Service/Unit:

This is to certify that the above loan application/borrower: This is to certify that the above loan applicant/borrower
(1) is a _/__permanent/___co-terminus employee of this Office has no pending administrative nor civil case charge against
and is not on leave of absence without pay; him/her based on the records on file with DepEd.
(2) has net pay of PhP ______________ for the payroll month &
year of _________________________________________ and
(3) has given the true and correct information on the loan
Application Form

ARNOLD M. BENABAYE ARNOLD C. COSTELO

ADMINISTRATIVE OFFICER V ATTORNEY III
DATE: DATE:
 SECRETARIAT'S ASSESSMENT / EVALUATION
A. Documents Submitted : (Two copies of each)
/ Loan Application Form (LAF) Additional documents for Additional Loan
/ Authorization to Deduct Letter Request
/ Latest Copy of Payslip (original)(borrower & co-maker) Hospitalization/Medical Expenses
/ Photocopy of DepEd ID (borrower & co-maker) Medical Abstract/Certificate/
Approved Appointment (for FIRST TIME borrowers and Prescription/Diagnosis
Co-terminus employees only) Barangay/LGU certificate/
Document showing proof that the co-terminus employee Resolution declaring the borrower's
has rendered at least 2 years in DepEd, e.g. Notarized place under State of Calamity
Contract of Service / Service Record Reviewed by:
Others (specify): _________________________________

B. Completeness and Veracity of Submitted Documen

/ Signed and completely filled out LAF
/ Complete supporting documents for type of loan applied fo
/ Signatures on LAF are by authorized signatories KENNY G. COMIDOY
Administrative Assistant III

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 brfore the maturity of his/her loan,
Age: ________
Borrower has Outstanding PF Loan Balance: Current Loan Balance : _______________
Borrower's Net Take Home Pay after deduction of Past Due Loans: ____________________
monthly amortization of the loan being applied for is No of years/Months Past-Due:______
equal 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: ______________%
Verified by:
CARRYVIC S. DUMAPIAS
Administrative Assistant III

D. Computation of Loan:
Principal Amount of Loan: Php ______________ Net Take Home after Deduction Php ________
Less: Outstanding Balance of Loan to be Renewed Monthly Amortization Php ________
Principal Php ____________ Period of Loan __________________________
Interest Php ____________ _______________ (mm/yy - mm/yy)
Net Proceeds Php
Date Processed: ________________________

Processed by: Reviewed by:

KENNY G. COMIDOY AILEEN N. DALAGAN
Administrative Assistant III Administrative Officer IV
ACTION TAKEN:
NOTE:
The Head Secretariat shall approve loans of Php 5,000.00 up to Php 50,000.00. Special loan of
Php 100,000.00 shall be approved by the Board Chairman.
Recommending Approval:

WINNIE E. BATOON, CESO V

Schools Division Superintendent
OFFICE OF THE SCHOOLS DIVISION SUPERINTENDENT
tional Loan

orrower's

ue:______

p ________
p ________
 AUTHORIZATION FOR SALARY DEDUCTION

Personnel Division
DepEd, F. Torres St., Davao City

I hereby authorize the deduction of ____________________________________________

pesos (Php__________________) from my salary ______ months, starting ____________________
to __________________________ or until my total outstanding loan of _______________________
____________________________ PESOS (Php _________________) has been fully paid. Amount
deducted shall be credited to the account of the DEPED PROVIDENT FUND as receivables on the
said loans.

(signature over printed name)

EMPLOYEE NO. __________________ DIVISION CODE: _______________ DESIGNATION: _________________

EMPLOYMENT STATUS: ___________ STATION CODE: _______________ YEARS IN SERVICE: _____________

AUTHORIZATION FOR SALARY DEDUCTION

Personnel Division
DepEd, F. Torres St., Davao City

I hereby authorize the deduction of ____________________________________________

pesos (Php__________________) from my salary ______ months, starting ____________________
to __________________________ or until my total outstanding loan of _______________________
____________________________ PESOS (Php _________________) has been fully paid. Amount
deducted shall be credited to the account of the DEPED PROVIDENT FUND as receivables on the
said loans.

(signature over printed name)

EMPLOYEE NO. __________________ DIVISION CODE: _______________ DESIGNATION: _________________

EMPLOYMENT STATUS: ___________ STATION CODE: _______________ YEARS IN SERVICE: _____________

AUTHORIZATION FOR SALARY DEDUCTION

Personnel Division
DepEd, F. Torres St., Davao City

I hereby authorize the deduction of ____________________________________________

pesos (Php__________________) from my salary ______ months, starting ____________________
to __________________________ or until my total outstanding loan of _______________________
____________________________ PESOS (Php _________________) has been fully paid. Amount
deducted shall be credited to the account of the DEPED PROVIDENT FUND as receivables on the
said loans.

(signature over printed name)

EMPLOYEE NO. __________________ DIVISION CODE: _______________ DESIGNATION: _________________

EMPLOYMENT STATUS: ___________ STATION CODE: _______________ YEARS IN SERVICE: _____________
as receivables on the

as receivables on the

as receivables on the