HQP-SLF-065

MULTI-PURPOSE LOAN (MPL) (V03, 05/2018)

APPLICATION FORM Pag-IBIG MID No./RTN APPLICATION No.
(To be filled out by applicant. Print this form back to back on one single sheet of paper)
Type or Print Entries 91418116994

LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., II) MIDDLE NAME MAIDEN MIDDLE NAME DATE OF BIRTH PLACE OF BIRTH
Gammoot Divina Baggas (For married women) December 14,1991 Lacnog,Tabuk, Kalinga

MOTHER’S MAIDEN NAME NATIONALITY SEX MARITAL STATUS CITIZENSHIP EMAIL ADDRESS
Eliza Binuloc Baggas Filipino  Male  Single  Widower  Annulled Filipino
 Female  Married  Legally Separated gammootdivina@yahoo.com
PRESENT HOME ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name CELL PHONE NUMBER (Required) HOME TEL. NUMBER
0935-802-7979
0956-100-7205
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code APPLICANT’S TAXPAYER SSS/GSIS No.
Lacnog Tabuk City Kalinga 3800 IDENTIFICATION NUMBER (TIN)
01-2391688-0
488-671-034-000
PERMANENT HOME ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name BUSINESS TEL. NUMBER NATURE OF WORK
0917-581-4676 Bank Loan Processing In-Charge
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code EMPLOYEE ID NUMBER DESIRED LOAN AMOUNT
Lacnog Tabuk City Kalinga 3800 12141994 Php 50,000.00

EMPLOYER/BUSINESS NAME DATE OF EMPLOYMENT LOAN PURPOSE

February 01, 2014 Non-Housing Related
Rural Bank of Rizal (K-A), Inc.  Livelihood/additional capital in small business  Vacation/travel
EMPLOYER/BUSINESS ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name  Tuition/Educational Expenses  Special events
 Payment of utility/credit card bills  Car repair
 Purchase of appliance & furniture/electronic  Health & wellness
gadgets
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
Babalag East, Rizal Kalinga 3808 Housing Related  Others, specify
 Minor home improvement/home renovation/ ________________
upgrades
PREVIOUS EMPLOYMENT DETAILS FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME EMPLOYER/BUSINESS ADDRESS FROM (mm/yy) TO (mm/yy)

SIGNATURE OF APPLICANT PAYROLL ACCOUNT/DISBURSEMENT CARD

In the event of the approval of my application for Multi-Purpose Loan, I hereby authorize
Pag-IBIG Fund to credit my loan proceeds through my Payroll Account/Disbursement Card that
NAME OF BANK/BRANCH
I have indicated on the right portion.

APPLICATION AGREEMENT
In consideration of the loan that may be granted by virtue of this application subject to the pertinent provisions of the This office agrees to collect the corresponding monthly
Implementing Rules and Regulations of Pag-IBIG Fund, I hereby waive my rights under R.A. No. 1405 and authorize amortization on this loan and the MS of herein applicant
Pag-IBIG Fund to verify/validate my payroll account/disbursement card. Furthermore, I hereby authorize my present employer, through salary deduction, together with the employer
______________________________________________________________________________ or any employer with counterpart, and remit said amounts to Pag-IBIG Fund on or
whom I may get employed in the future, to deduct the monthly membership savings (MS) and monthly amortization due from before the 15th day of each month, for the duration that the loan
my salary and remit the same to Pag-IBIG Fund. If the resulting monthly net take home pay after deducting the computed monthly remains outstanding. However, should we deduct the monthly
amortization on MPL falls below the monthly net take home pay as required under the GAA/company policy, I authorize Pag-IBIG amortization due from the applicant’s salary but failed to remit
Fund to compute for a lower loanable amount. it on due date, this office agrees to pay the corresponding
penalty charged to applicant equivalent to 1/20 of 1% of any
I understand that should I fail to pay the monthly amortization due, I shall be charged with a penalty of 1/20 of 1% of any unpaid unpaid amount for every day of delay and penalty for non-
amount for every day of delay. remittance equivalent to 1/10 of 1% per day of delay of the
If for any reason excess loan proceeds are erroneously credited to my payroll account/disbursement card, I hereby authorize amount payable from the date the loan amortization or
Pag-IBIG Fund to debit/deduct the excess amount from my account without need of further notice of demand. Should my payments fall due until paid.
account balance be insufficient, the Fund has the right to demand for the excess amount to be refunded.
I authorize Pag-IBIG Fund to disclose, submit, share or exchange any of my account information to legal and government NERISSA L. ORODIO
_________________________________________
regulating agencies, other banks, merchant partners or third party in accordance with R.A. No. 9510 and other related or HEAD OF OFFICE OR AUTHORIZED SIGNATORY
pertinent laws and regulations. The credit information may also be transferred to service providers (e.g., Credit Information (Signature over Printed Name)
Corporation, Bankers Association of the Philippines - Credit Bureau), likewise in accordance with laws and regulations.
I certify that the information given and any or all statements made herein are true and correct to the best of my knowledge
Manager
_________________________________________
and belief. I hereby certify under pain of perjury that my signature appearing herein is genuine and authentic. DESIGNATION
91418116994
______________ _______________ ______________
DIVINA B. GAMMOOT
___________________________________ Pag-IBIG AGENCY CODE BRANCH CODE
Signature of Applicant over Printed Name EMPLOYER ID NO.
PROMISSORY NOTE
For value received, I promise to pay on due date without need of demand to the order of 5. I shall be considered in default in any of the following cases:
Pag-IBIG Fund with principal office at Petron MegaPlaza, 358, Sen. Gil Puyat Avenue., City a. Any willful misrepresentation in any of the documents executed in relation hereto;
of Makati the sum of Pesos: b. Failure to pay any three (3) consecutive monthly amortizations;
c. Failure to pay any three (3) consecutive membership savings;
(P_______________) Philippine Currency, with an interest at the rate of 10.5% per annum d. Violation of any of the membership/STL/housing loan policies, rules, regulations, and
(equivalent rate of 17.50% based on diminishing principal balance), with interest during the guidelines of the Pag-IBIG Fund.
grace period and shall be amortized equally over the term of the loan. 6. In the event of default, the outstanding loan obligation shall become due and shall be
deducted from the TAV after exerting all collection efforts. However, immediate
I hereby waive notice of demand for payment and agree that any legal action, which may offsetting of my outstanding loan obligation may be effected immediately upon approval
arise in relation to this note, may be instituted in the proper court of Makati City. of my request, provided such request is based on the following justifiable reasons and
upon validation by the Fund: Borrower’s unemployment; illness of the member-borrower
Finally, this note shall likewise be subject to the following terms and conditions: or any of his immediate family members as certified by a licensed physician that, by
1. I shall pay the amount of Pesos: _______________________________ reason thereof, resulted in his failure to pay the required amortization when due; or
(P_______________) through salary deduction, whenever feasible, over a maximum death of any of his immediate family members that, by reason thereof, resulted in his
period of 24 months, with a grace period of 2 months. In case of suspension from work, failure to pay the required amortization when due.
leave of absence without pay, insufficiency of take home pay at any time during the 7. In the event of membership termination prior to loan maturity, any outstanding loan
term of the loan, payments should be made directly to the Fund or its accredited obligation, shall be deducted from my TAV and/or any amount due me or my
collecting agents. beneficiaries in the possession of the Fund. In case of my death, the outstanding
2. Payments are due on or before the 15th day of the month starting on obligation shall be computed up to the date of death. Any payment received after date
_________________________ and 23 succeeding months thereafter. of death shall be refunded to my beneficiaries.
3. Payments shall be applied according to the following order of priorities: Penalties, 8. In case of falsification, misrepresentation or any similar acts committed by me,
Interest and Principal. Pag-IBIG Fund shall automatically suspend my loan privileges indefinitely. I shall abide
4. A penalty of 1/20 of 1% of any unpaid amount shall be charged to me for every day of with all the applicable rules and regulations governing this lending program that
delay. Pag-IBIG Fund may promulgate from time to time.
Signed in the presence of:
JUNE C. SAYSON ELMER A. MORALES
________________________________ ________________________________ DIVINA B. GAMMOOT
__________________________________
Witness Witness
(Signature over Printed Name) (Signature over Printed Name) Signature of Applicant over Printed Name

AUTHORITY TO DEDUCT (Optional)

In case of retirement/separation from employment, I hereby authorize my employer to deduct any outstanding MPL balance from my retirement SIGNATURE OF APPLICANT
or separation benefits to fully settle my loan obligation. In the event that my retirement/separation benefit is not sufficient to settle the outstanding
balance of my MPL or my employer fails for whatever reason, to deduct the same from said retirement/separation benefits, I hereby authorize
Pag-IBIG Fund to apply whatever benefits are due me from the Fund to settle the said obligation.

THIS PORTION IS FOR Pag-IBIG FUND USE ONLY

RECEIVED BY DATE REVIEWED BY DATE APPROVED/DISAPPROVED BY DATE

THIS FORM CAN BE REPRODUCED. NOT FOR SALE

 HQP-SLF-065
GUIDELINES AND INSTRUCTIONS (V03, 05/2018)
A. Who May File
Any Pag-IBIG Fund member who satisfies the following requirements:
1. Has made at least 24 monthly membership savings (MS);
 A member who has withdrawn his MS due to membership maturity or who has optionally withdrawn his
MS, cannot obtain an MPL unless and until after he has subsequently paid 24 MS following the month of
CERTIFICATE OF NET PAY the said withdrawal
 A member, who does not meet the required 24 MS, may nevertheless, be allowed to avail of an MPL if his
total savings is at least equivalent to 24 MS at the rate applicable to him.
2. Has made at least one (1) MS within the last six (6) months prior to the date of loan application;
3. If with existing Pag-IBIG housing loan, the account must not be in default as of the date of application;
4. If with existing MPL and/or Calamity Loan, the account/s must not be in default as of date of application; and
5. Has sufficient proof of income.
DIVINA B. GAMMOOT
B. How to File
The applicant shall:
NAME OF BORROWER 1. Secure the Multi-Purpose Loan Application Form (MPLAF) from any Pag-IBIG Fund branch or download from
Pag-IBIG website at www.pagibigfund.gov.ph.
2. Accomplish 1 copy of the application form.
For the month of: _________________
JULY 2019 3. For releasing of loan proceeds through Payroll Account/Disbursement Card, attach photocopy of payroll
account/disbursement card/deposit slip (for newly-opened account).
4. Submit accomplished application, together with the required documents to any Pag-IBIG Fund Branch.
Processing of loans shall commence only upon submission of complete documents.
Php 15,500.00 C. Loan Features
Basic Salary _________________ 1. Loan Amount
A qualified Pag-IBIG member shall be allowed to borrow an amount based on the lowest of the following:
Add: Allowances 1.1 Desired Loan Amount
1.2 Loan Entitlement
The loan entitlement shall be equivalent to eighty percent (80%) of TAV. However, If the borrower has
Representation Allowance 3,000.00
_____________________ __________ an existing calamity loan, the loanable amount shall be the difference between the 80% of the borrower’s
TAV and the outstanding balance of his calamity loan.
1.3 Capacity to Pay
Travelling Allowance 3,000.00 The loanable amount shall be limited to an amount which will not render the borrower’s Net Take Home
_____________________ __________ Pay (NTHP) to fall below the minimum requirement as prescribed by the General Appropriation Act (GAA)
or company policy, whichever is applicable.
2. Interest Rate
_____________________ __________ The loan shall be charged with an interest of 10.5% p.a. (equivalent rate of 17.50% based on diminishing
principal balance) with interest during the grace period and shall be amortized equally over the term of the
loan.
_____________________ __________
3. Loan Term
The loan shall be repaid over a maximum period of twenty-four (24) months, with a grace period of two (2)
_____________________ __________ months.
4. Loan Release
The loan proceeds shall be released through any of the following modes:
_____________________ __________ a) Crediting to the borrower’s disbursement card;
b) Crediting to the borrower’s bank account through LANDBANK’s Payroll Credit Systems Validation
(PACSVAL);
c) Check payable to the borrower. However, when the check remains unclaimed for a period of thirty (30)
calendar days from the DV/Check date, the loan shall be cancelled.
21,500.00 d) Other acceptable modes of disbursement.
Gross Monthly Income __________ 5. Loan Payments
5.1 The loan shall be paid in equal monthly payments in such amounts as may fully cover the principal and
interest over the loan period. Said amortization shall be made, whenever feasible, through salary
deduction.
Less: Deductions 5.2 For self-employed individuals, Overseas Filipino Workers (OFWs), or other types of individual payors,
monthly payments shall be paid over-the-counter or any other modes of payment approved by the Fund.
5.3 Payments shall be remitted to the Fund on or before the fifteenth (15th) day of each month, starting on the
HDMF LOAN 1,048.00 third (3rd) month following the date on the DV/check or manual disbursement voucher.
_____________________ __________ 5.4 If the due date falls on a non-working day, the monthly amortization shall be paid on the first working day
after the due date.
HDMF CONTRIBUTION 240.00 5.5 The borrower may fully pay the outstanding balance of the loan prior to loan maturity.
_____________________ __________ 5.6 The borrower shall pay directly to the Fund in case the borrower is unable to pay through salary deduction
for any of the following circumstances:
SSS CONTRIBUTION 620.00
a. Suspension from work
_____________________ __________ b. Leave of absence without pay
Issued this _______ day of _________, 137.50
PHIC CONTRIBUTION
20__. c. Insufficiency of take home pay at any time during the term of the loan; or
I_____________________
certify under pain of perjury that __________
the above- d. Other circumstances analogous to the foregoing.
mentioned information is true and correct. 5.7 Payment shall be applied according to the following order of priorities:
SAVINGS DEPOSIT 200.00 a. Penalties; if any
b. Interest; and
____________________ __________ c. Principal
5.8 Any amount in excess of the required monthly amortization shall be applied to succeeding amortizations
D. ___________________________________________ which will be posted on the next due date.
_____________________
Loan Renewal __________
HEAD OF OFFICE/AUTHORIZED SIGNATORY 6. Penalties
E. Loan Renewal (Signature
over printed name) A penalty of 1/20 of 1% of any unpaid amount shall be charged to the borrower for every day of delay. For
borrowers paying through salary deduction, penalties shall only be reversed only upon presentation of proof
that non-payment was due to the fault of the employer. In such case, penalties due from the borrower shall
2,245.50 be charged to the employer. Non-remittance of the total loan amortization shall likewise subject the employer
with a penalty of 1/10 of 1% per day of delay of the amounts payable from the date the loan amortization or
Total Deductions __________ payments fall due until paid.
7. Default
The borrower shall be in default in any of the following cases:
a. Any willful misrepresentation made by the borrower in any of the documents executed in relation hereto.
Php 19,255.00 b. Failure of the borrower to pay any three (3) consecutive monthly amortizations.
Net Monthly Income __________ c. Failure of the borrower to pay any three (3) consecutive MS; or
d. Violation by the borrower of any of the membership/STL/housing loan policies, rules, regulations and
guidelines of Pag-IBIG Fund.
8. Effects of Default
In the event of default, the outstanding loan obligation shall become due and demandable. The outstanding
loan obligation shall be deducted from the TAV after exerting all collection efforts.
D. Other Provisions
1. The MPL and/or Calamity Loan programs shall be treated as separate and distinct from each other. Hence,
the member shall be allowed to avail of an MPL while he still has an outstanding calamity loan, and vice versa.
20th AUGUST 19
Issued this _______ day of _________, 20__. Application for loans on these two programs shall be governed by their corresponding guidelines. The
outstanding loan balance of the calamity loan shall not be deducted from the proceeds of the MPL.
2. In no case, shall the aggregate STL exceed eighty percent (80%) of the borrower’s TAV.
I certify under pain of perjury that the above- 3. A borrower may renew his MPL after payment of equivalent to six (6) monthly amortizations; not earlier than
mentioned information is true and correct. sixth (6th) monthly amortization due date; and provided that he meets the eligibility requirement. The proceeds
of the new loan shall be applied to the borrower’s outstanding MPL obligation and the net proceeds shall then
be released to him. In case of full payment prior to loan maturity, a borrower shall be allowed to apply for a
new loan anytime thereafter.
NERISSA L. ORODIO 4. In the event of membership termination prior to loan maturity, the outstanding balance shall be deducted from
___________________________________________
the borrower’s TAV and/or any amount due him or his beneficiaries in the possession of the Fund. In case of
HEAD OF OFFICE/AUTHORIZED SIGNATORY borrower’s death, the outstanding balance shall be computed up to the date of death. Any payments received
(Signature over printed name) after death shall be refunded to the borrower’s beneficiaries.
5. Offsetting of the borrower’s outstanding MPL balance against his TAV shall be effected immediately upon
approval of the borrower’s request; provided, such request is based on any of the following justifiable reasons
and has been verified by the Fund: Borrower’s unemployment; Illness of the borrower or any of his immediate
family members as certified by a licensed physician that, by reason thereof, resulted in his failure to pay the
required amortizations when due; Death of any of his immediate family members that, by reason thereof,
resulted in his failure to pay the required amortizations when due.
6. If TAV offsetting has been effected on the borrower’s defaulting MPL, he may apply for a new MPL provided
he has paid at least 6 monthly amortizations prior to default and its consequent offsetting against the
borrower’s TAV. However, if he has paid less the than 6 monthly amortizations prior to default, he may apply
for a new loan only after two (2) years from the date of TAV offsetting.