Republic of the Philippines WA SOCIAL SECURITY SYSTEM LT | MEMBER LOAN APPLICATION ez) STFA RAY OS REPRODUCED BD SWOT FON TALE TS CAN ALSO WE DORMDADED THR TN BS WERITE A wang IDLERSE READ THE INSTRUCTIONS AND REMINDER AT THE BAGK OF THE FORM AND THE ATTACHED TERNS AND CONDITIONS BEFORE ACCOMPLISHING ‘THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY. ‘PART 1- TO BE FILLED OUT BY MEMBER BORROWER. “K MEMBER-BORROWER DATA SS TET SOMMTON REFERENCE aes DATE OF BATH cern) TARTDENTINGATION NOMEN PEE ee te fe eae ete | ee eee me ROORESS a SETSTS TET a EET STS TT aa Fone | Li RSORESS RRR TE FRI T reer aT oT Er RE ae HELEFRONE WOGER aco NOBTEICELLPVONE NOTEER ERR ROORESS titi jiiiitiiititiiit OREN ADDRESS ouNTY Barco er CORTE SORT APES FO I saty Oi sexe Ol oe e RIGDE GP PATENT Tara SOT Cnfes wa Puan 1 (UM) ATM Cas Cl easnows Doms i ose ot Payment ash Cara pRereRneD Sank EAST CAROIEATIS RECOUNT NO. Tae np TT TD uncrigark fhe Piepines “CERTIFICATION, AGREEMENT AND PROMISSORY NOTE atthe formation proved In his form are true and correc. 2. | agree with the TERMS AND CONDITIONS attached to this loan application. 3. | unconeltionaly promise o pay the amount stated inthe confirmed Loan Disclosure Statement issued. T citoank NA Prigines PRINTED NATE, SNATORE DATE EPCOTER TOWER [TIX DENTTATON HUMBER or TPEGF ENPLOVER rei gir iit PP Lt [essen 1 Howat eRTovER RIE eRPLOTER REDRESS UREA FEET FRTTRKT TR aS AUTRES rd Fa Brae | HELERHONE WEEN aaa EMA ROORESS TEBE Poxacanass PCO B_CERTICATION provided i Ws Torn are Tue and correct Also, Tagroo with the TERMS AND CONDITI Tat the formation Biached To WS loan application PAINTED RANE SGNATURE POSTION TE DATE FART Ill. MEMBER- BORROWER'S AUTHORIZATION authorize whose signature appears below, To fle my Member Loan Application ‘and to affix signature inthe "Conforme” portion of Disclosure Statement on Loan/Credit Transaction in my behalf and cause the receipt thereof, whichever is applicable SIGNATURE OVER PRINTED NAVE OF — DATE —TSIGNATURE OVER PRINTED NEGF pate STHORZED REPRESENTATIVE PART IV- TO BE FILLED OUT BY SSS JRECEIVED AND ENCODED BY Finan 0 caratdocurnent 7 two vats 10 cords or documents, one wi photo & both signature [omer to carsieocumont “BORATUREOVERPRINTEDNAME POSTIONTIIE _DATEANDTINE BRANCH [REVIEWED BY TSGRATURE OVER PRINTED RAVE POSTON, DATE ARO TINE, Tepubic afte Praspes [SOCIAL SECURITY SYSTEM MEMBER LOAN APPLICATION ACKNOWLEDGEMENT STUB ISS NO/COMMON REFERENCE NO am NAME STE eR EETETATE i a ( f RECEVED SY ‘SGNATURE OVER PRINTED NAME POSTON TE, DATES TE BRANCHINSTRUCTIONS Fillout this form in one ‘Aways indicate "NIA" or Not Applicable’, the required data isnot applicable ‘Aways affix intals onal erasures/alteration/s on tis frm, Present orginal copy of valid entiation cards/documents, Refer to "List of F's Valid Identification (ID) Cards/Documents” below. “The signatory in Part IB ofthis form should be the employer or one ofthe authorized signatories inthe "Employer Specimen Signature Card ‘Applicaton for salary loan releases thru-the-bank shal be fied personaly by the member-borrower LIST OF FILER'S VALID IDENTIFICATION (ID) CARDS/IDOCUMENTS FLED BY TEMBER BORROWERS IDENTIFICATION REQUIREMENTS IREPRESENTATIVE/EMPLOYER)| COMPANY mecemernonnowet EMPLOYER'S REPRESENTATIVE REPRESENTATIVE Hone (i) Primary 1D cardlGocument of the member 7 7 7 bonower (Present orga (Present he ora (Present ne oa oR Two (2) Secondary 1D cardsidocuments of the member bonower {both wth signature and atleast one (1) wth phot] lz One i) Primary 10 —_caraldocument of the] 7 ‘epsesentaie/empioveremplovers, (Present ine niga) atveleompany oR Two (2) Secondary ID cardsidocuments of the! ‘mpressotativelemploveremplover's, ‘mresentative/company rencesentave tooth wth signature and at easton (1) wih phot] fs Authorized Company Representatve (ACR) Card 7 (Present ne cranan Notes: 1. For securty agencies and employers with branches but with centralized fing of loan applications, photocopy of the above cited ‘documents auly certifies by the member and authenticated by the authorized company signatory shall also be accepted in leu of the ‘original ID card(sy'document(s) 2, All equivalent ID cardsidocuments with Englsh translation issued by foreign govemments and presented by OFW members for fing of ‘shortterm member loan applications are acceptable, ‘A. Primary ID Cards/Document 1. Social Security ($8) Card 4. Passport 2 Unified Mutt-Purpose ID (UMID) Card '5. Professional Regulation Commission (PRC) card 3. Drivers License 8. Seaman's Book (Seafarers dentfication & Record Book) B. Secondary ID Cards/Documents 1. Alen Certificate of Registration 10, 1D card issued by Local Government Units (LGUs) (e.g. Barangay! 2. Certificate of Licensure/Qualifeation Documents fom Municipalty/City) Maritime Industry Authority 11, ID card issued by professional association recognized by PRC. 3. Certifeate trom any ofthe folowing whichever is applicable: 12, Mariage ContractiMarrage Cerificate > National Commission on Indigenous Peoples 13, Overseas Worker Wellare Administration (OWWA) Card > National Commission on Musi Filipinos 14, Philippine Health Insurance Corporation (PHIC) ID Card 4. Company ID Card 15, Police Clearance or NBI Clearance 5 Firearm License card issued by Philippine National Police (PNP) 16. Postal ID Card 6. Fishworke’'s License issued by Bureau of Fisheries and 17, School ID Card ‘Aquatic Resources (BFAR) 18, Seafarers Resistration Certificate issued by Philippine Overseas 7. Government Service Insurance System (GSIS) Members Employment Administration (POEA) FecordiCerificate of Membership 19. Senior Ctizen Card 8. Health or Mecca! card 20, Student Permit issued by Land Transportation Office (LTO) 9. Home Development Mutual Fund (PAG-IBIG) Members Data Form 21. Taxpayers Identification Number (TIN) Card 22, Voters Identification CardlAtidavivCertiicate of Registration REMINDER 1. Unified Mult-Purpose 1D (UMID) ATM Card mode of payment isthe default mode of payment for member-borrowers with activated UMID ATM. Card. The loans will be directly credited tothe SSS-issued UMID ATM account. Incase the member-borrower has no activated UMID ATM Card, helshe shall be given an option on the mode of payment ofthe proceeds as follows: a, Thre Cash Card [Citbank N.A.Philppines/UnionBank ofthe Philippines] . Taru Check 12 Verification of status may be made thru the SSS Website at www sss gov ph or contact cur Call Center 820.6448 up to 86 oF 917-7777 THERWI: RUTH IN LENDING ACT ‘A DISCLOSURE STATEMENT ON LOAN TRANSACTION SHALL BE ISSUED BY SSS TO THE MEMBER-BORROWER UPON APPROVAL OF HIS/HER MEMBER LOAN APPLICATION. WARNING |ANY PERSON WHO MAKES ANY FALSE STATEMENT IN THIS APPLICATION OR SUBMITS ANY FALSIFIED DOCUMENT IN CONNECTION WITH THIS APPLICATION SHALL BE LIABLE CRIMINALLY UNDER SECTION 28 OF R.A. 8282 OR UNDER PERTINENT PROVISION OF THE REVISED PENAL CODE OF THE PHILIPPINES.TERMS {SSC Res. No, 316-5.2012 dated 18 Apri 2012) A. ELIGIBILITY REQUIREMENTS ‘Al employed and currently contributing settemployed or voluntary members applying for salary loan must meet the folowing ebgiilty requirements: 1. Fora one-month salary loan, the member-borrower must have tity sx (36) posted monthly contribution, six (6) of which should be within the last twelve (12) months prior to the menth of fling of application 2. For a twommonth salary loan, the member-borrower must have seventy-two (72) posted monthly contributions. six (8) of which shoula be within the last twelve (12) month prior othe month offing of application 3. The employer ofthe employed member-borrower must be updated inthe payment of contribution and loan remittances. 4. The member-borrower must = have net been granted any final beneft(.e, total permanent sisabilly, retirement, andior death benefits) = be under shtyfve (5) years of age athe time of application for ean = have not been disqualified due to fraud committed against the SSS. 'B, LOANABLE AMOUNT 1. A one-month salary loan is equivalent to the average of the member-borrower’s 12 latest posted Monthly Salary Credits (Q4SCs), rounded tothe next higher MSC, or amount applied for, whichever is lower. 2. A two-month salary lan is equivalent fo twice the average ofthe member-borrowers 12 latest posted MSCs, rounded to the next higher MSC, or amount applied for, whichever i over. ‘3. The net amount ofthe loan shal be the approved loan amount less service fee and outstaning b member loan, if any. (C, REPAYMENT TERM AND SCHEDULE OF PAYMENT 4. The loan shall be payable within two (2) years in 24 equal monthly amortzations. 2. The monthly amortization shall start onthe 2 month folowing the date ofthe approval ofthe loan, which is due on or before the 3 deadline, as follows: For Employers (ERS) nce of previous short-term 110th digit of the 13-digit | Payment Deadline Itiast digit of the ER ID number is: a ‘8S number is: applicable month) applicable month) Tore Toth day ofthe month Torr Bora 75th day ofthe month ora 75th day ofthe month Soré oth day ofthe month Sor6 oth day ofthe month Tor8 26h day ofthe month Tor8 25th day ofthe month Last day ofthe month ast day ofthe month For OFW members, the payment deadline ison or before the 10th day of the month folowing the applicable month, 3, Payment shall be made at any SSS branch office with automated tering system, SSS-accredited bank or SSS-authorized payment center. D. INTEREST AND PENALTY 1, The loan shall be charged an interest rate of 10% per annum until fully paid, computed on diminishing principal balance, and ‘shall be amortized over a period of 24 months 2. Any excess in the amortization payment shall be applied tothe outstanding principal balance, 3. Loan amortization not remitted on due date shal beara penalty of 1% per month. 4 Ifthe loan is not fully paid atthe end of the term, interest and penalty shall continue to be charged on the outstanding principal balance until fully pia E. SERVICE FEE A service fee of 1% of he loan amount shal be charged and deducted from the proceeds ofthe loan F. LOAN RENEWAL 1. Renewal of loan shall be allowed after payment of st least 50% cf the original principal amount and ven at least 12 months has lapsed. 2. Proceeds of renewed loan may be any smouint greater than or aqual to previous loan has been deducted G. RESPONSIBILITIES OF THE EMPLOYER 1. The employer shall be responsible forthe collection through payroll deduction and remittance to the SSS of the employed member-borrower’s salary loan. 2, In case the employed member-borrower is separated volunatly (e.g, retirement or resignation) or involuntary (e.g. termination of employment or cessation of operations ofthe company) from the company, the employer shall deduct the total Dalance of the loan ftom any benefivs due the employee and shall remit the same in full to SSS, 3, The employer shall report to the SSS the effective date of separation from the company and the unpaid loan balance of the ‘employed member-borrowe, through the collection lst, ifthe benefvs due the employed memiber-borrower is/are insufcient to fully repay his her loan, 4. The employor shal require a new employee to secure from the SSS an updeted statement of his/her account, deduct from his/her salary the amortization due and remit the payment to SSS. H. RESPONSIBILITY OF MEMBER-BORROWER ‘Amember-borrower who transfers employment shell sucute from the SSS and suinit to his/her new empioyer an updated statement (of account of any outstanding loan balance wit: SSS and allow hisiner employer to dedvct from hisMher salary the corresponding ‘amortzation due, including any inlerestior pencity for late rernitance. |. DEDUCTION OF UNPAID LOAN FROM BEHEF!IS In case of default and the memoer-horrowor fails to bamediately nay the cuts the inlerest and penalty ‘hereon, chalibe ecttaa front the bones claimed by te member, 2s folows: # Feremployes, final benefits (total dsabsityletrernentisoath), # For seltemplayod voluntary member, short tm berets ‘Sickness’Matoritj/P'itial Disabil) or final benefits (otal dieabilty! retirementdestn) ‘OTHER CONDITIONS 4. Any overpayment on a grevious loan shal! be eppied to the current loan. if any. If thar is no current loan, the ovemaymient cen also be refunded upon request of the member-boirower, 2, The member-borrower shal noty the Member Services Section ofthe ne ‘address - they SS Form €-4 fled overthe counter (OTC) '. emplayes- thr a notice went thru mal, fled OTC, or sent ns e-mail. membor_rolations@sss.gov-ph. The rotce s include the SS number, name and signa’ure uf te mamber-porrowsr BASTSS, OTHERWISE KNOWN AS “TRUTH IN LENDING AST DISCLOSUPE STATEMENT, ON ILQAN TRANSACTION SHALL BE ‘SGUED BY S88 TO THE MEMBER, JEORROWER UPON APPROVAL OF HISIHER !.OAN APPLICATION. « . provided that the outstanding balance on the amortization due st SSS branch office of any change in the following