_________________
Date of Application
APPLICATION TO PURCHASE A HOUSE AND LOT PACKAGE/HOUSING UNIT
UNDER THE GOVERNMENT EMPLOYEES HOUSING PROGRAM
THE REGIONAL MANAGER
Thru: The District Manager
Sir:/Madame:
In accordance with NHA rules and regulations which I and my family agree to comply with faithfully, I
hereby apply: (please check)
A.1. FOR PURCHASE OF HOUSE AND LOT PACKAGE under the GEHP thru
Cash Sale End-User Financing (MTO-Pag-IBIG)
PROJECT NAME (see attached Annex for list): ____________________________________________
A.2. TYPE OF HOUSING
2-Storey Duplex Low-Rise Building/Condominium
1- Storey Duplex
A.3. As Government Employee of _______________________ (please specify)
I. APPLICANT'S IDENTITY: (For female applicant/spouse, give complete maiden name)
NAME: _____________________________________________________________________________
(Last) (First) (Middle) (Mother's Surname)
Residence/Address: ___________________________________________________________________
Date of Birth: ___________ Place of Birth: _______ Civil Status: __________ Citizenship: ____________
Contact Numbers (Residence): _________________________ Office: ___________________________
Email Address: _______________________________________________________________________
TIN No.: _______________________________ GSIS/SSS/Pag-IBIG Policy No.: ___________________
Name of Spouse: _____________________________________________________________________
(Last) (First) (Middle) (Mother's surname)
Date of Birth: _________________________________ Place of Birth: ___________________________
II. APPLICANT’S EMPLOYMENTS STATUS
Nature of Employment: ______________________
Name of Agency/ Corporation: _______________________
For Military/Police Personnel:
Rank: _____________________ Place of Assignment: _____________________
Position:__________________________ (at the time of application)
Salary Grade:______________________
Date Hired:________________________________ Mother Unit:
_____________________________________
No. of years in the Government: ____________________
For Government Employees:
Position:____________________________
Salary Grade:_________________________
Date Hired:______________________________________
No. of years In the Government:______________________
III. APPLICANT'S FAMILY COMPOSITION (add additional page if necessary):
NAME RELATION TO CIVIL STATUS AGE EMPLOYMENT/SOURCE
APPLICANT OF INCOME
_____________________ _______________ ______________ ________ ______________________
_____________________ _______________ ______________ ________ ______________________
_____________________ _______________ ______________ ________ ______________________
_____________________ _______________ ______________ ________ ______________________
IV. APPLICANT'S TOTAL FAMILY INCOME PER MONTH: (P______________________)
V. FAMILY REAL PROPERTY HOLDINGS: (please underline)
Have never availed of any form of government housing assistance, nor violated Section 14 of RA 7279
(YES/ NO)
VI. CERTIFICATIONS
I/We certify that the foregoing information/statement is to my/our knowledge, true, correct,
complete, and updated. The signature/s appearing above my/our name/names below is/are genuine.
I/We authorize National Housing Authority (NHA) or its duly authorized representative to verify
necessary information or data (i.e. certificate of employment, pay slips and income tax return) with the
concerned government agencies or third parties including banks and other financial institutions from
whom NHA had obtained information.
I/We hereby agrees that any misrepresentation of a material fact is a ground for disapproval of
the application, cancellation of the loan, and shall be a cause for the total outstanding obligation to be due
and demandable and shall be subject to other sanctions provided in existing NHA guidelines. I/We agree
to notify NHA of any material change affecting the information contained herein. I/We agree that all
information obtained by NHA) shall remain its property whether or not the loan is granted.
I/We further agree to be bounded by the current and general policies of NHA and those that the
NHA may adopt in the future, that may have relation to or in any way affect my/our loan.
I/We understand that the processing/service/filing fee, notarial and all other incidental fees
pertaining to the registration of mortgage on property shall be for my/our account.
__________________________________________ _______________________________________
SIGNATURE OVER PRINTED NAME OF BORROWER SIGNATURE OVER PRINTED NAME OF SPOUSE
__________________________ __________________________
DATE DATE
SUBSCRIBED AND SWORN to before me in_________________________Philippines, this
______ day of _____________________ 20____, AFFIANT, having exhibited to me, his/her ID No.
__________________ issued on ________________ at _________________________.
Doc. No. __________ NOTARY PUBLIC
Page No. __________
Book No. __________
Series of 20
Note: Please provide complete information and write legibly in PRINT /BLOCK LETTERS
