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Application Form For Gsis - Loan

This document is an application form for a GSIS loan for employees of the Department of Education in the Philippines. It requires personal information, employment details, and a certification of the applicant's status and income. The form must be signed by both the applicant and the school head for validation.

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mark san andres
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144 views1 page

Application Form For Gsis - Loan

This document is an application form for a GSIS loan for employees of the Department of Education in the Philippines. It requires personal information, employment details, and a certification of the applicant's status and income. The form must be signed by both the applicant and the school head for validation.

Uploaded by

mark san andres
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region V
DIVISION OF CAMARINES SUR
Freedom Sports Complex, San Jose, Pili, Camarines Sur

APPLICATION FOR GSIS LOAN

Type of Loan Applied:_________________________

NAME OF APPLICANT:

Last Name First Name Middle Name


Birth Date: Age:
Residential Address:
School Assignment:
Division/Station/Employee Number :
UMID Card No. (The twelve digits number in your UMID card)
Have you Applied for GSIS loan previously?
If yes type of loan applied: Date of Application:
Date of Original Appointment:
Status of Employment: E-mail Address:
Cell Phone Number: Office/Home Phone Number:
I hereby certify under oath that:
(1) I am in the active service;
(2) I have no pending administrative case and/or criminal charge;
(3) The information supplied by the undersigned is true and correct;
(4) I am not on leave of absence without pay;
(5) That as of the month of __________ 2024, the following appears in my Pay Slip:
Gross Monthly Income: _________________________
Total Deductions: ______________________________
Net Take Home Pay: ____________________________
(6) The monthly amortization shall be deducted from my monthly salary;
(7) In case of separation from the service of the borrower, clearance shall first be
obtained from the GSIS before any document and/or final payment is released in
my favor.

(Signature over Printed Name of borrower)


Date Signed:__________________________________

Attested:

MARITES V. CASTUERA
(Signature over Printed Name of the School Head)
Date Signed:__________________________________
Mobile Phone Number: 09478191212

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