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Form preview Multi purpose loan application... HQP-SLF-065 MULTI-PURPOSE LOAN APPLICATION FORM MPLAF TO BE FILLED OUT BY APPLICANT For IISP LAST NAME AGREEMENT ID Type or print entries NAME EXTENSION e.g. Jr. II FIRST NAME MIDDLE NAME MAIDEN NAME For married women PRESENT HOME ADDRESS Unit/Room No* Floor Building Name Lot No* Block No* Phase No* House Subdivision Province/State/Country if abroad Street Name DESIRED LOAN AMOUNT Max of 60 24-59 mos. Max of 80 at least 120 mos. Max of 70 60-119 mos. Other please specify LOAN PURPOSE Please refer to List of Loan Purpose at the Guidelines and Instructions portion BIRTHDATE mm Barangay Municipality/City BIRTHPLACE dd ZIP Code MOTHER S MAIDEN NAME TYPE OF LOAN yyyy MARITAL STATUS Single/Unmarried Married EMPLOYER/BUSINESS NAME Annulled SEX Renewal SSS/GSIS ID No* Male HOME TEL* No* Female MOBILE PHONE No* Required OFFICE TEL* NO. Widow/er Legally Separated Pag-IBIG MID No*/RTN New FOR AFP EMP-SERIAL/ACCOUNT No* FOR DECS EMP - DIV. CODE/STATION CODE/ EMPLOYEE No* TIN DATE OF Pag-IBIG MEMBERSHIP EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP Mo. Yr. Use another sheet if necessary NAME OF EMPLOYER ADDRESS FROM Mo. /Yr. TO Mo. /Yr. MEMBER S PAYROLL ACCOUNT/DISBURSEMENT CARD NUMBER SIGNATURE OF APPLICANT 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 I HAVE INDICATED ON THE RIGHT PORTION* NAME OF BANK/BRANCH BANK ADDRESS APPLICATION AGREEMENT In consideration of the loan that may be granted by virtue of this application subject to the pertinent provisions of the Implementing Rules and Regulations of Pag-IBIG Fund I hereby waive my rights under R*A. No* 1405 and authorize Pag-IBIG Fund to verify/validate my payroll account/disbursement card. Furthermore I hereby authorize my present employer or any employer with whom I may get employed in the future to deduct the monthly Pag-IBIG contribution and amortization due from my salary and remit the same to Pag-IBIG Fund* If the resulting monthly net take home pay after deducting the computed monthly amortization on MPL falls below the monthly net take home pay as required under the GAA/company policy I authorize Pag-IBIG Fund to compute for a lower loanable amount. I understand that should I fail to pay the monthly amortization due I shall be charged a penalty of 1/20 of 1 of any unpaid amount for every day of delay. If for any reason excess loan proceeds are erroneously credited to my payroll account/disbursement card I hereby Should my account balance be insufficient the Fund has the right to demand for the excess amount to be refunded* I certify that the information given and any or all statements made herein are true and correct to the best of my knowledge and belief* I hereby certify under pain of perjury that my signature appearing herein is genuine and authentic* This office agrees to collect the corresponding monthly amortizations on this loan and the monthly contributions of herein applicant through payroll deduction together with the employer counterpart contributions and remit said amounts to duration that the loan remains outstanding.

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