Republic of the Philippines SOCIAL SECURITY SYSTEM Annex A.1 Tons CALAMITY LOAN ASSISTANCE APPLICATION "THis FORA MAY Bi REPRODUCED AND Id NOT FON GALE Thus CAN ALSO BE DOWNLOADED THRU THESES WEBSITE AT wor sen aor oh (TIEASE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK OF THE FORM AND THE ATTACHED TERMS AND CONDITIONS BEFORE ACGONPLISHING THIS FORM _PRINT ALL INFORMATION IN CAPITAL LETTERS ANO USE BLACK INK ONLY. N 7A MEMBER DATA MN RERERECE WORE BEDE BRT aT rele POM Se TL = tii ADRES IFRS TIA aT itd pir TEEORE MOWER en ROTEL RETO ERAT RIOR rele ey eer Epa rae IMOGE OF PARENT aes a= Di Uitiod hut Purp 1D (UNIO) - ATI Card 1 Goch Card cic i Wode of Payment is Cash Card J>ncreRRED BANK [CASH CARDISAVINGS AGCOUTN WO Tobe sed warn oe ca 1D Catark W.A. Prippines DLunwrsenk ot ne Priors EL EERTIACATION, UNDERTAKING AND PROWISSORY ROTE Ta iy reSWdence @ TOCSIEG In The Goclred calamity area and was affected by heppenedon (data). 2. | early that my Rouselproperty was damaged by the said calamity amourting to P 3-_| cert that he information provided n this application form are tive nd corect. | Incase ie proven that | have given fale information or misepresentatcn inthis document or in any cthar documents submited cennecton wan my Calamty Loan Assetance Appicaton, the tots! culstanding loan balance shall become due and demandabe end | promise 19 ‘remediately pay in ful the said arsourt ‘5. | agree win the TERMS AND CONDITIONS attached to is loan application 5 | uncendisonally promise to pay the amount stated in the Disclosure Statement under the Calamity Loan Assistance Program that I have ‘conformed win. Trarne a caumiy) woh PRINTED NAME OF MEMBER SGRATURE ATE PART TO BE FILLED OUT BY EMPLOYER (FOR EMPLOYED MEMBER) ee ETERS REE LITT EATON NIE aT OF EMPTOR fe) ey ney Lit i tb ii bt Ieee Trewern San TERRES ar RTS CRE —— sara ane 111 Li T-CERTFEATION Tal he Wormabon provdee W Tis Tam are Woe and correct Aso Tages winthe Tl loan application as eOTEET Je rimary 10 cart Ee Sere [Jrwe vai 10 cass, oon: signature 8 aiteast one wi prota] “SIGNATURE OVER PRINTED NAME POSIOW TITLE GATEANO TIME "BRANCH eee eas een WA canon EINE Bcxnon ACKNOWLEDGEMENT STUB. Ee Es ee FEceneDey POSTONTIE DATE RTE BRANCHINSTRUCTIONS. Fi au ths form in ane (t) copy Incjeate "N/A" the requed datas nt appoabl ‘Als nts ona eraurosiaaratons on tis form I fhed op metbee-subme te folewing stary 38S Erench Otice ‘2. Appleaton For fer CLA- orignal eany Barangay Certicaion -crginal copy © Provert cngnal copy ef vad ID cerdsltocurrants of ne autherzed represarave. Refer to"Ust of Fis Vaid \etiteaton (1) Carés:Doeuments belo 11 oe by suthoriced representative for OFW!Seatararremtur), suomi the fllowng any SSS Banch Otic | Apreahon Form for CLA -ongne copy > Autnervation Leiter - eginl eepy Barangay Certfictien - erin! copy ‘S Prnted scanned copies of wall ID cardsléocumenta of tne OFWiSesfater member and presen! orginal cases of vad 1D cards/cocumerts of the _ashonzed representatve Refer 2 "Lstl File’s Vaid ‘ertiicaton ID) Gaics/Docurerts" below: The signatory in Pati of tis form shal be the empoyet er one of he authorzed signaates inthe "Employer Specimen Signaiue Card 88 Form 501i" LIST OF FILER'S VALID IDENTIFICATION (1D) CARDS/DOCUMENTS CALAMITY LOAN ASSISTANCE PROGRAM Present the orignal copy & any one |t) primary 10 cardidacurent tern or two (2} secondary iD cardsisocumenesin Wem B, both wth sionatire ane at least ona (1) ih phot, A Pray ID CardsiDocuments. + Sox Seeuy (88) Care 4, Passpet 2 Unie Mu-Purpase ID (UMD) Card 5. Profesional Regustien Comission (PRC) cad 4 Dwar Llearse 6, Seaman's Sook Seatare’ Identification & lecors Book) 8, Secondary 1D GardsiDecuments | Alen Geniteate of Registraton 10. 1D cad issued by Locel Government Unis (1CUe) (eg. Barangay! 2 Cerficele of LeaneireiGuliieaton Documents trom Maritime Munetbaltycty) Incustry Autrorty 11, (end taues by professional association recegnized by ARC 3. Certicate tram any at the flowing, shichever s appicatie 12 Mamtage Contrac:Marnage Cerfcate > Natonat Gorssien on laaigenous Peopies 3 Overaeat Worier Weare Administraton (OWA) Card > taionat Commesen on Musim Flipinos 14. Prilppine Healt insurance Corperaden (PHIC} 1D Gard 4 Garpany 19 Gard 18 Posce Crarance or NBI Clearance 5 Freerm License card issund ty Phiingine National Pokce (PNP) 16 Pesalid cae 5 Fisnverners License issued by Bureaue of Fisheres and Aguatc 17, Sehaot ID Care Resourees [3FAR) 18. Seafarers Registaton Cetiteste issved by Phigpne Oversees 7 Goverrmen Service Insurance System (GSIS) Members Employment Adminstration (POEA) RecardiCer ficate of Marnberstip 18, Senor cttzen Cara 8, Hearnor Medina card 2. Student Perri iesued by Land Transpotatien Office (LTO) 2. Home Development Mil Fund (PAG: (BIG) Member's DalaForry 2. Taxpayers lsemricaton Number (TiN) Card Da. Voters identical CateiticaverCeriicate of Registration ote All equialect (D eardedceuments with English Fanelation iecuad by frelon gcverrments and preserted by OFW mertbers or ng of CLA acploatos are accestabe 3755, OTHERWISE KNOWN AS "TRUTH IN NG ACT" [ADISCLOSURE STATEMENT ON LOAN TRANSACTION SHALL BE ISSUED BY 585 TO THE NENBERS UFON APPROVAL OF THEIR CALAMITY LOAN 'ASS STANCE PROGRAM APPLICATION, WARNING ANY PERSON WHO MAKES ANY FALSE STATENENTIN THE APPLICATION OR SUBMITS ANY FALSIFIED DOCUMENT IN CONNECTION VITH THIS. APPLOATION SHALL BE LABLE CRIMINALLY UNDER SECTION 28 CF R.A. 8282 OR UNDER PERTINENT PROVISON OF THE REVISED PENAL CODE OF THE PHILIPPINES, REMINDERS + Une Mu-Purpeae 19 (UMD) ATH Card made ef payment is he etnut mae of gaymant or mambots wih activated UMID ATM Card. The laans wl be ar eety {iestac toe SoSvesved UNO ATM scours, thence tha meme! has no actvated UMIO ATM Cate aise shall 2 ven an epton cn Ine nase ol paymantol the proceens a ftw 2 Thu wh GarsiCtiberk NA PrippinestinarBanc of t@Pipsros 3. Thu check 2 Yorfaton ot sits may be made th the SSS Wiebsits or eles members on at iw S88 9o¥ pm oF contact ou Cal Center st $23-8848 up 029.0 9 Hes,(SSC Ros, No, 523.2017 | Date: July 14,2017), ‘®. COVERAGE OF THE PROGRAM Members who ae rosidants ofthe calamty erckan areas as deciaed and may be declared by the Natonal Disaster Risk Resiucton and ‘Menagorvent Counell (NORRMC) ard who suftered losses o damages loti properie lecated im he ead calamity schon areas 2. ELIGIBILITY REQUIREMENTS ‘Al careny conrbuing employed, sel-employed anid voluntary members appling fer calamnty Joan assistance must meet the follwing sgt exuirements 1) The employed member's empbyer must be updaind inthe paymant of conrbuons ané loan emittances, as eppllenble 2. ‘The member must have at eget thirty (28) posted morthy ceriibutions. she (6) of wtih should be posted within fe last twelve (12) months pir to the mort of ing of application. be a resident of the calamity declares areas and suifered lossesitamagss 1 thelr propertes. A resden fs ne wo has a home ‘addroseipropent st he richer are, have not been g'ante any fra: bene, (16, otal permanent Asabity.reternentand dee) tthe tre of appt, not have an oustanding restuctured loan under the SSS Loan Restnicuring Pregran (LRP) or oustanding Calamity Loan Assistance rogram (CLAP) . AVAILMENT PERIOD Appleation for calamity lean assistance shal be ted witun thre (3) ments fom te insuance of Crear No D. LOANABLE AMOUNT The loan emount shall be equtatert to one (7) mortiy alary Ces (MSC) computed based 0° the average of he lst 12 MSCs or the ota mount of damages as certfied by the member i fe application form, (rounded uo othe nearest housanc), wnictever i ower E, REPAYMENT TERM AND SCHEDULE OF PAYMENT : {The lan shal be payable wihin two (2) years 24 equal monthly instlimects 2 Tw marth amarteaticn shal stat onthe 2" morih fellow te date ofloan. which is due on or bate tha Seadine, 28 flows For omployers (ERS) rare reer IW the last digit of the: Chines, | Last gay ofthe month sti “OFW members, the payment deadine on ot bolore fe TOM day ofthe meni flown The applicable month 3. Payment sna be made a any SSS branch ofce with fering fly, SSS-accredted bank, or SSS-auihoniced payment center INTEREST AND PENALTY 1) The loan shal De charged an interest ae of 10% per annum computed on @ cimirishing pipe balance, 2. Any excess n the arorizaton payment shal be applied othe uts'anding pri balance 3. Loan amonzatinypayments no emited on due date stullbear te peoaly of 1% per month unt fly paid 44 the lan is nt uly pase at the end ofthe tom, intrest of 103% per annum and penalty of 1% pa marth shall continu to be charged on ‘oustanding principal balance url ly pass G. SERVICE FEE ‘Service foe of 1% shal be waives 1H, RESPONSIBILITIES OF EMPLOYER 1 The employer shal be response for he colectlon trough payroll deducien and remitarce fo the SSS cf te arvonizaion due on the employed members calamty loan assistance 2. The employer shal deduct he toll balaice of he loan Fam any company benef ic the member and ghal rrr the camo in fl 10 SSS in case the member 18 separated fiom the company volumatty (2... retrement or resgnatin) oF wwolumtarly (€g. Yeminaten of ‘employment of casestion of operations of thw company) ‘3. The employer shall ‘eno fo the SSS the effective date of separation from the compeny and the urpalé an balance af he empboyed rmonber, through the collation li, the company berets insueent to fully r9pay the loan 4 Theemplyer shal reaute a new employee to Secure fam he SSS en updated statement o outbtarsing ian account ay. ‘5. Theamployer shal doduict ard remt to SSS ary autstanding lan balarce of naw enployeos |L_ RESPONSIBILITY OF MEMBER ‘Members wie transfer employment shall sutra fo halt new ompioyer an updated etaleient of wocourt of any oustanding ‘oan balance wth ‘$85 and alow thee employe’ to dnout fom thei salary the commespanding amortzation due, mckuding any inteestox penelly fr late remitarce 4. DEDUCTION OF UNPAID LOAN FROM BENEFITS: In case the mamter fal to mediately pay te oustanding balance, the arearagachnpar loan. as walla the interes! and penalty thereon ‘snail De deucted tom te Donets being caimed by Fre member 2 flies ‘+ Foremployed mamiber- fnal bereft (oa dleabityretromenticesth) For seltemployedvchintny member - sertierm benems (Skckriess/MaerityPariat Disabaty) ct frat benefits (total Aisabutyretremartideath) K. OTHER CONDITIONS 1. The member must personally aoply forthe Calamity Laan Assistance Program ts any SSS branch offices (Over-the-Counter). 2. For Overseus Filpne Workers (OFWaY Sealers, the members musi issue an Authorization Letter in favor of their authrizad Fepresentatwes authoring the ler oe Fei Calamity Loan Asssiarce application ter beta 2. The member mus aut « Certiteaton a8 proct hat hey ae afected bythe Armd Corie in Marawd Cy, Lanao Del Sur rom any ofthe felewing (a) Barangay, (b] City Mayo, (e) Department of Socal Welere and Dereiopment (OSWD), d) Native! Disaster Risk Resucton ‘and Nanaerrant Counc INDRRMC}, 0) Local Eisaster Risk Reduction and Managment Councl (LORRMC), crt) Pole ‘The member must cert the exter of damages, (1 peso equivaer, i thei home/pranety ‘This calamity ban rust be ful pal! befor the member can aval tutu caiamty oars of SSS Cher terme and conditions in the existing ealay loan guidalines rot inconsistent wit tho ubove proviions s rogram, 7. The member shally the Member Services Section ofthe rrest SSS branch office of any change inthe following ‘ aoaress - nau 9S Form E-4 flee ove-he-courter (OTC) 1 empioyer thru a notice sent trum, led OTC. or sart thn e-mail member rlationsd@sss gov ph The notice shall include the SS umber, name ard sgratire ofthe member 8 Calamity Loan Assistance check may be picxec.up by te momber/auhonced representative (for OF W'Seatarer member) at SSS Branch be apical i this