WEALTHBANK DEPED SALARY LOAN APPLICATION FORM. LAST NAME FIRST NAME MIDDLE NAME, HOME ADDRESS: sex: 7] mae [7 remus ainrHoay: Ace: ‘on sTarus: NO OF DEPENDENTS, HOME TEL. No. SCHOOL TEL, No, MOBILE NO, ‘SCHOOL NAME: SCHOOL ADDRESS: DIVISION: STATION: EWPLOYEE NO: Tw: aieLovMent status: Poston, ATE HED, ANY UPCOMING LOAN DEDUCTION?[—] YES [—]NO IFYES,\NDICATE BANKS NAME AMOUNT ‘OTHER SOURCESIAMOUNT OF mcoME: LOAN PURPOSE: Agrcutural Major Car Repair House Repair thers (Pis. Specty) Tuition Fee Purchase of Apptances Hospitalization LOAN AMOUNT _ P. “LOAN TERM Im connection with my lan application thereby acknowedge and autores: 1) the regular eubmision and diclosure of my base credit dats (as defined under Republic Act No, 910 and ks Implamentng rules and regulations to he Credit formation Corporation (Ic), aswel a ary Updstes or coreconstheroot and 2) the sharing of my basi cred cata wth oer lenders authorized by the CIC, and cred reporting agencies duly acceded by the CIC. AGREEMENT (ie ati hateach ofthe statment made nhs aplation se and comet and gre to notte bank of any mateal change acing he tomate ‘etn hero, We autores you cain and very such formato a maybe requod covering hi afpentn, You may epree or test mou epoeton a your ‘ale dace, ie undersans at ehould mou appcaton be dered, Weathbankhas no lgaton cn pro uri fhe reason on su recon, Further, We ‘2970 tat af foraton cise by Weathbank shal rans opr whee ote an 8 ane, BORROWER: ‘CO-MAKER: Sie a Fa ET Tice Har Pt Naa) (CO-MAKER INFO: 1S Borrower Requirements: Home Address: © 1 pcs. 2x2 Picture For New loans Only) aaa nla oe nse Fully fled up Depéd Application Form ane ff Photocopy oft Valid ID's (PRC, DEPED, GSIS & School io) | Bithday: omnes Ne with specimen signature TIN Number: Poston: Appointment or Service Record (For New loans Only) rina 3 months consecutive latest ORIGINAL payslip Co-maker requiremen oes eae —— 5 Photocopy of 1 Vaid IDs (PRC, DEPED, GSIS, School 10) Divison, Station___Employee No___ with 3 specimen signature. Government / Schoo! 1D No, Buy-Out: Latest Statement of Account peer Date: Signed For Bank Use On)WEALTHBAN DISCLOSURE STATEMENT ON LOAN/CREDIT TRANSACTION {As Required under R.A. 3765, Truth in Lending Act) NAME OF BORROWER ‘ADDRESS Division: STATION: EMPLOYEE NO. 1. LOAN AMOUNT 2, OTHER BANK CHARGES/ DEDUCTIONS COLLECTED ‘a. Documentary/Science Stamps P. 'b. Mandatory Credit insurance P Others (Pls. specify) P 3. NET PROCEEDS OF LOAN (Item 1 less Item 2 and 3) 4, SCHEDULE OF PAYMENTS. 2. Single Payment due on (Date) Php. b. Installment Payments (Please see attached amortization schedule) 5. EEFECTIVE INTEREST RATE (Interest and Other Charges) Explanation: The effective interest rate is higher than the contractual interest Rate of because of Item 2 deduction above. 6. CONDITIONAL CHARGES THAT MAY BE IMPOSED (If applicable). Please specify manner of imposition: a. Late Charges b. Prepayment (penalty/refund) ©. Others (Ps. specify) CERTIFIED CORRECT: (Signature of Creditor / Authorized Position Representative Over Printed Name) NOTES: Itemized all charges including advance deductions. Small business/Retail/Consumer Loans include micro, auto (motor), salary, personal, medical, educational and other loans of similar nature, This document contains the minimum information required to be disclosed to the borrower and maybe enhanced to improve client information. | acknowledge receipt of a copy of this statement prior to the consummation of the credit transaction and that | have read and understand and fully agree to the terms and condition thereof BORROWER ecm err (CO-BORROWER gnc onromanenfane)AUTHORITY TO DEDUCT of the loan granted to me by Wealthbank, VWe, the undersigned Borrower and /or Co-orrowers, hereby authored the Division of the Department of Education (DepEd) or its Paymaster, to deduct from my/our salary and/or other benefits due me, the sum of ( ) for (_Y consecutive monthly saris beginning ‘and overy monty slaresUneealier and remit the ‘anoant vo Weal This Authorization is VALID AND BINDING unti my/our aforementioned loan is fly paid Executed this day of at Lucena City, Quezon, Philippines. Loan Amaunt PN No. ate Granted Maturity Date PROMISSORY NOTE FOR VALUE RECEIVED, We the undersigned, hereby jointly and severally, promise to pay WEALTH DEVELOPMENT BANK CORP,, (WEALTHBANK) oF its ORDER, at its Head Office in Cebu City, or in any ofits Branches, the Principal Amount of loan granted plus interest and other ‘Charges indicated in detail inthe Disclosure Statement On Loan/Credit Transactions found atthe back hereof. This loan is granted under the following terms and condition, 4. Interest ate at (___)perannum, 2. Term and payment Payable equal monthly amortizations, through monthly salary deductions, at (e per amortization, starting ‘and every salary thereafter until the total loan, Including the Taterest, penalty [Wan and other chargess fully pala Fos this purpose, the undersigned borrower and/or co borrowers agree and hereby authorized the Payroll Service Division of the Department of Education (DepEd) or Paymaster of DepEd to deduct the sald amount from the salary ofthe undersigned Borrower and/or co-borrowers. 3. Penalty: Delay n the payment of the amortization due shall be charged with late payment penalty of four percent (4%) per month of the total ‘amount due, Should this Note or any portion thereof not pald upon maturity the undersigned borrower and/or co-bocrowers agree to jointly and severaly pay 2 penalty o liquidated damages equivalent to four percent(4%) per month of the total amount due which at no instance shall be less than P3.000.00, ‘4 Acceleration Clause + In case of non-payment for two (2) consecutive amortization/nstallments, WEALTHBANK reserves the right to consider the {entire Balance ofthe loan due and demandable, notwithstanding the Imposition of applicable penalties, 5. In case of death, resignation, retirement, dsmisal, or separation from the service for any other reason, the WEALTHBANK Is empowered and authorized to ask, demand, collect and recelve from my/our employer, government or private or from any association or organization of which /WE Is/are member/ , such as 85/6SIS,PPSTA or other Insurance companies, an amount In cazh/checks o treasury warrants to be deducted from my/our benefits, pensions, or Insurance proceeds, or any other emoluments which/we may be entitled, to be apple In satisfaction of my/our loan obligation, 66 _ Should it become necessary to endorse this NOTE to an attorney for collection thereof, an attorney’ fe of atleast One Thousand Pesos (P2,000.00) ‘may be charged against me/us, and if suit is INSTITUTED to enforce collection thereof, an attorney's fee of TEN PERCENT (10%) of the total amount collectible, at no instance les than P5,000.00 plus the cost of expenses of tigation of no less than P500.00 shall be for my/our account. Incase of ‘execution I WE hereby expressly WAIVE the benefits of SECTION 12, RULE 39, Rules of Court 7. IAWE acknowiedge receipt of a copy of this PROMISSORY NOTE and DISCLOSURE STATEMENT found at the back of this page prior to the loan |ansaction and that WE undarstand and fully agree to the terms thereof. '8. This instrument shall also be Binding upon my/our helrs, successors, executors, administrators and/or asians. INWHINESS WHEREOF, Ihave hereunto set my hands this, ay of at Lucena City, Philippines Borrower Signature over Printed Name/bate) — iv No, sta No. Employee No. DWv.No. _ Sta. No, Employee No. Signed in the presence of Date AAPPENDUM: ATTENTION TO CO-MAKERS: ‘As comakers ofthe loan herein contracted, we are aware that we severally liable with the borrower and we are fully aware of our lability 2s, such, thats, we bind ourselves to pay the loan and all charges incidental thereto as willbe demended in accordance with the terms and conditions of ths Promissory Note, inthe event the borrowers falls to pay, for whatever reason, NOTE the borrower's furnished a duplicate copy of his note, RECEIVED COPY By: Borrower ATE Blgnatare over Printed Name)