DSWD EMPLOYEES MULTI-PURPOSE COOPERATIVE IN CARAGA (DEMPCC)

DSWD Field Office Caraga, Butuan City

(Fill-up this form completely. Incomplete application form will not be processed)

ID #: _____________________
NAME OF BORROWER: _____________________________________ Age: ____ Sex: ____ Date Filed: _____________
Home Address: ____________________________________ Birthdate (m/d/yy): _____________ Civil Status: ___________
Employer/Office Address: _________________________________ Contact No. ________________ Tin No. ____________
Program: _______________________________________________ Employment Status: ____________________________
Name of Spouse: _______________________________ Spouse Occupation: ____________________ No. of Children: ____
Type of Residence: Owned____ Rented____ Other (specify)_________________________

NAME OF CO-MAKER 1: __________________________ Age: ___ Sex: ____ Civil Status ________ Birthdate: _________
Address: _____________________________________ Birth Place: ________________________ Contact No. _____________
Program: _______________________________________________ Employment Status: ______________________________
TIN No. ______________________ CTC No. ________________ Date/Place Issued: _________________________________

NAME OF CO-MAKER 1: __________________________ Age: ___ Sex: ____ Civil Status ________ Birthdate: _________
Address: _____________________________________ Birth Place: ________________________ Contact No. _____________
Program: _______________________________________________ Employment Status: ______________________________
TIN No. ______________________ CTC No. ________________ Date/Place Issued: _________________________________

The Credit Committee:

I hereby apply for credit (LBP) / regular loan in the amount of ______________________________ (Php_________) payable in full
within ___________________ (_____) months with instalment payment to be made every month in the amount of Php___________.
Loan Type: _____________________________
Loan Purpose: ___________________________
Mode of Payment: ________________________
Collateral: ______________________________

Signature of Borrower

I / We, ______________________________ of legal age, Filipino and resident of _______________________________________

granted:
That being the Co-Maker of ___________________________________ whose loan was granted by the cooperative, in the
amount of ______________________________________________ (Php_____________), I hereby in myself to assume the
obligation jointly and severally in case the borrower ______________________ will not pay his/her account with DEMPCC.
I will further assume full responsibility in paying the full account in case the borrower will transfer residence outside his/her
Station thereby making collection to him/her ineffective.

________________________________ ________________________________
Co-Maker Co-Maker

ACTION OF THE CREDIT COMMITTEE

CALE P. PINEDA
Operations Manager
LILIBETH BORDARIO MARIA REA R. SAMPIANO
Loan Officer Credit Committee Chairman
GLEZZA TAMBABA-TY
APPROVED____ DISAPPROVED____ Reason/s: _______________________________ DEMPCC Chairman

PAYROLL DEDUCTION AGREEMENT

I will assure via payroll deduction their amortization effective immediately upon approval and release of the aforementioned
amount.
I certify agreement to all the terms and condition set forth in this loan document.

Witnessed and Concurred by:

Certified Correct:

MARY CHILL S. LUMINARIAS-MOMO _______________________ _______________________

Personnel Officer Borrower Spouse
 PROMISSORY NOTE
PN. No. __________________________ DATE GRANTED: ____________________________
AMOUNT: __________________________ DUE DATE: ____________________________
For value received, I promise to pay to the order of the DSWD Employees Multi-Purpose Cooperative in Caraga (DEMPCC) at its
office located at Capitol Site, Butuan City the sum of _________________________________________ only (Php_______________),
with 2% diminishing interest monthly, and all fees and surcharges, within a period of 24 months in monthly instalments from the
granting of the loan at Php______________________ per month.
To ensure prompt payment of the instalment on due date, I hereby assign to DEMPCC my wages, salaries, allowance and allied
instruments, from all sources, and appoint our respective Disbursing Officer, as our attorney-in-fact to deduct there from such amounts
required under this note. Should I fail to pay my instalment, I oblige to pay a surcharge of 2% per month for every amount due. If I fail
to pay the instalments for three (3) successive months, my capital build-up will be offset without prejudice to penalty charges and other
charges.
In the event the period covered by the insurance taken to ensure the indebtedness, subject thereof, or that taken on the property made
as collateral for said indebtedness, has elapsed without the loan having been fully paid, the DEMPCC is hereby authorized to renew
the said insurance and advance the corresponding premiums thereof, which advance payments shall be charged to me with the same
interest rate with that stipulated herein.
In the event that this note is placed in the hands of an attorney for collection, I shall pay 10% of the amount due on the note as attorneys
fee’s which in no case shall be less than P500.00 exclusive of all cost and fees allowed by law and stipulated in this note. In case of
judicial enforcement of this obligation or any part of it, I waived all my rights under the provisions of Rule 39, Section 12, of the Rules
of Court, and I shall pay 30% of the amount due on the note as attorney’s fees, which in no case shall be less than FIVE HUNDRED
PESOS (P500.00) exclusive of all cost and fees allowed by law and as stipulated in this note.
DEMAND AND DISHONOR WAIVED. Holder may accept partial payment reserving his right of recourse against each and all
endorsers.
Recommending Approval:

_______________________________ ___________________________ CALE P. PINEDA

Name & Signature of Borrower Name & Signature of Co-Maker Operations Manager

Signed in the presence of: _____________________________ ______________________________

DEED OF ASSIGNMENT
KNOW ALL MEN BY THESE PRESENTS:
That I, _____________________________________________, Filipino of legal age, hereinafter known as the ASSIGNOR.
The DSWD Employees Multi-Purpose Cooperative in Caraga (DEMPCC) represented by its BOD Chairman
GLEZZA TAMBABA-TY, hereinafter known as the ASSIGNEE.
That for and in consideration of the sum of ________________________________________ (Php______________) that the
ASSIGNOR obtained from ASSIGNEE, ASSIGNOR has by these presents, assign his/her Salary/Pension Check to ASSIGNEE to
deduct in full the monthly payment of ________________________________________ (Php____________) until full payment has
been made.
I further certify that in the event of my resignation or termination as employee of the Department of Social Welfare and
Development (DSWD), I hereby authorize our Personnel Unit to effect deduction of the total amount needed to liquidate my loan
balance (i.e. retirement pay, termination pay, leave credits, etc.).
A penalty shall be imposed as stated in the promissory note, in case of failure of payment of the above monthly amortizations.

GLEZZA TAMBABA-TY __________________________________

ASSIGNEE ASSIGNOR
ACKNOWLEDGMENT

SUBSCRIBED AND SWORN to before me this _______day of _____________, 2017 in BUTUAN CITY, PHILIPPINES,
personally appeared.
Name Comm. Tax Cert. No. Date/Place of Issue

Known to me to be the same persons who executed the aforegoing instrument, subscribing under oath the matters set forth in
the application appearing on the reverse side hereof and acknowledge the same to their free and voluntary act and deed.

Doc. No. ______________

Page No. ______________ ________________________________________
Book No. ______________
Series of 2017