Republic of the Philippines W/4 SOCIAL SECURITY SYSTEM <4 =f CALAMITY LOAN ASSISTANCE APPLICATION "THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE. THs CAN ALSO BE DOWNLOADED THRU THE S88 WEBSITE AT wan songoreh PLEASE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK OF THE FORM AND THE ATTACHED TERMS AND CONDITIONS BEFORE ACCOMPLSHING “THIS FORM PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY. [COMION REFERENCE NUMBER =a) RTS PROTESTS SRR Ter CODE MAING ADDRESS TOF RO EBS WT POSE EER WOT REET ROSEN TREES eR a CODE FELEPHONE NUMBER wmcacooe-Ta12) | MOBILEICELLPHONE NUMBER [EMA ADDRESS LEtditititititiiiiiy FOREIGN ADDRESS warrccaaiey [GOUNTRY jae cone ROSE OF PATENT soso Unite ut Purpoe 10 (UNIO) - ATM Cad 1 can cont Core ode of Payments Cash Card pcrenReD aan [GASH CAROISAVINGS ACCOUTNNO. ew icv ana h e can WA. Pipes Z Unendank ot ne Pines Tears tat ny rencarce Ws Woated The declared calamity area and was aeced by Tame oT ear wR happenedon (dae) \certy tat ry houselpropery was damaged by the said calamity amounting to | cert hath ntrmaton povided nthe appcton fm are tue and corect Incase tis proven that have given fale information or msrepesentaton in hs documento in any ater documents submited in connection wth my Calamity Loan Asstance Applicaton, the fla oustanding loan balance shal become duo and demandable and | promee to inmedatoly pay nfl the sid amount "agree wh the TERMS AND CONDITIONS atached tots loan application | unconditenally promise fo pay the amount stated inthe Discosure Statement under the Calamity Loan Assistance Program that | have confomad wih PRINTED NAME OF MEMBER ‘SIGNATURE TONER HYPE OF ENPLOVER Litiiiitit | | Cains tweets EMPLOYER NAME ENPLOVER ADDRESS TFET HO TBS AIT TOURETTES RETR STS BRETT ERMA FROME ep COoE | ELEPHONE NUMBER wacacoxsta to) EMAIL RODRESS WEBSITE sox anes BunoTER, Teertfy hat the information provided in tis Torn are Tue and correct Also, Tagraa wit the TEF loan application PRINTED NAME. ‘SIGHATORE: POSTION TIE, PART Ill TO BE FILLED OU [IDENTIFICATION CARDS OR DOCUMENTIS PRESENTED] RECEIVED AND ENCODED BY [7 Primary 10 cars —_ SITE UMEMOTIE —TANGT wo val 10 cas, oth signature Bat astcnewi phoo|_ “SIGNATURE OVER PRINTED NAWEPOSTTONTINE DATEANDTIME BRANCH ter I cars or documents JREVieweD By ‘SIGNATURE GVER PRINTED NAVE. POSTION TIE DATE ARO TE Repti he Prippres SOCIAL SECURITY SvSTEM CALAMITY LOAN ASSISTANCE APPLICATION ACKNOWLEDGEMENT STUB SSO CONG REFERENCE NO asa Tarn ORT a LLfiititiiy REcEWED EY ‘SIGNATURE OVER PRINTED NAME POSTION TLE, DATES TE,INSTRUCTIONS. Fillout this frm in one (1) copy. Indicate "N/A" ifthe required data is not applicable [Af inialson all erasures/aterations on this form If fled by member, submit the folowing at any SSS Branch Office: Application Foim for CLA - eriginal copy b. Barangay Certfication - original copy © Present orginal copy of valid ID cardsidocuments of the authorized representative. Refer to “List of Filers Valid Identification (1D) Cards/Documents" below. 5. If fled by authorized representative (for OFWiSeafarer member), submit the folowing at any SSS Branch Office: Application Form for CLA - orignal copy . Authorization Letter - original copy ©. Barangay Certification - original copy 4. Printed scanned copies of valid ID cards/documents of the OFWiSeafarer member and present anginal copes of vali ID cardsidocuments of the authorized representative. Refer to List of File's Vali Identficaton (ID) Cards/Docurets” below. 6. The signatory in Part I-B of this form shall be the employer or one of the authorized signatories inthe "Employer Specimen Signature Card (88 Form L501) LIST OF FILER'S VALID IDENTIFICATION (ID) CARDS/DOCUMENTS CALAMITY LOAN ASSISTANCE PROGRAM Present the original copy of any one (1) primary ID cardidocument in tem A or two (2) secondary ID cards/documents in item B, both with signature and atleast one (1) with photo, [A Primary ID Cards/Documents Social Secutty (SS) Card Uniea Muit-Purpose ID (UMID) Card Drivers License 4. Passport ‘5. Professional Regulation Commission (PRC) card 6. Seaman's Book (Seafare’s Identification & Record Book) 'B. Secondary ID Cards/Documents 1. Allen Ceticate of Registration 10. 1D card issued by Local Goverment Units (LGUs) (eg, Barangay! 2. Certificate of Licensure/Qualification Documents from Martime _-Municpalty(Cty) Industry Authosty 11. ID card issued by professional association recognized by PRC. 3. Cemticate ftom any ofthe folowing, whichever is applicable: 12. Marriage ContractMariage Certificate > National Commission on Indigenous Peoples 13, Overseas Worker Welfare Administration (OWWA) Card > National Commission on Muslim 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. Fishworker's License issued by Bureaue of Fisheries and Aquatic 17. School ID Card Resources (BFAR) 18, Seafarers Registration Certificate Issued by Philppine Overseas 7. Government Service Insurance System (GSIS) Member's Employment Administration (POEA) RecordiCerificate of Membership 19. Senior Citizen Card 8. Health or Medical caré 20, Student Permit issued by Land Transportation Office (LTO) 9. Home Development Mutual Fund (PAGBIG) Member's Data 21. Taxpayers Identfication Number (TIN) Cara Form 22. Voters Identification CardAfidaviCertcate of Registration Note: All equivalent ID cards/documents with English translation issued by foreign governments and presented by OFW members for fing of CLA, appications are acceptable. RA. 3765, OTHERWISE KNOWN AS “TRUTH IN LENDING AG |ADISCLOSURE STATEMENT ON LOAN TRANSACTION SHALL BE ISSUED BY SSS TO THE MEMBERS UPON APPROVAL OF THEIR CALAMITY LOAN ‘WARNIN [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 26 OF RA. 6282 OR UNDER PERTINENT PROVISION OF THE REVISED PENAL CODE OF THE PHILIPPINES. REMINDERS, 1. United Nast: Purpose ID (UMIO) ATM Card mode of payment isthe defaut made of payment for members win actated UMIO ATM Card. The loans wil be dec Creatas to he SSS-8qued UMID ATM account. Incase the member has no activated UMID ATM Card, else stall be ven an opton on he mode of payment of he proces Thru Cash Car [Citbank NA. Philpines/UnenBank of he Piippnet > ThnuCheck 2. Verfleaton of stats may be made tu the SSS West or enoled members ony) at waw ss govah or contact cur Cal Center at 920-6446 upto $6 or 817. m7.TERMS AND CONDITIONS FOR CALAMITY LOAN (SSC Res. No.: 782-6.2016 Date: 08 Novomber 2016) ‘A. COVERAGE OF THE PROGRAM Members who are residents of the calamity sticken areas as declared and may be declared by the National Disaster Risk Reduction and Management Councl (NDRRMC) and who suffered losses or damages to their properties located in the said calamity sticken areas. ELIGIBILITY REQUIREMENTS ‘A currently contributing employed, setemployed and voluntary members applying for calamity loan agsistance must meet the following elgibity requirements: 1. The employed member's employer must be updated inthe payment of contributions and loan remittances, as applicable 2. Te member must + have at least tity-sic (96) posted monthly contibutons, six (6) of which should be posted within the last twelve (12) ‘months pir tothe month of fing of appicaton. + be a resident ofthe calamity declared areas and suffered losses damages to ther properties. A resident is one who has @ home address/property a he stricken ares = have not been granted any fina benef, (total permanent sisbityretrement and death) a the time of application. not have an outstanding restructured loan under the SSS Loan Restructuring Program (LRP) ©. AVAILMENT PERIOD ‘Appicaton for calamity loan assistance shall be fled within three (8) months from the issuance of Circular No, 2016-007 . LOANABLE AMOUNT ‘The loan amount shall be equivalent to one (1) monthly salary credit (MSC) computed based on the average ofthe last 12 MSCs oF the total amount of damages as certified bythe member inthe application form, rounded up to the nearest thousand), whichever is lower E, REPAYMENT TERM AND SCHEDULE OF PAYMENT 1. The loan shall be payable wih two (2) years in 24 equal monthly instalments, 2 The monthly amortization shall start on the 2° month folowing the date of loan, whichis due on or before the payment adie, a8 lows For employers (ERS) For sairompr TorOFW rember Te payne desine Sonor bea Te 100 Gyo he non oawng ro spieab rene 3. Payment shall be made at any SSS branch offce wih telering facliy, SSS-accredited bank, or SSS-authrized payment center F, INTEREST AND PENALTY 1. The loan shall be charged an interest rate of 10% per annum computed on a diminishing prinpal balance. 2. Any excess inthe amortization payment shal be applied tothe outstanding principal balance 3. Loan amorization/payments not remitted on due date shal bear the penalty of 1% per month unt uly pai 4. Ifthe loan is not uly aid atthe end ofthe term, interest of 10% per annum and penalty of 1% per month shall continue to be charged on the outstancing principal balance unt fuly paid G. SERVICE FEE Service fe of 1% shal be waived H. RESPONSIBILITIES OF EMPLOYER 1. The employer shall be responsible for the collection through payroll deduction and remittance tothe SSS of the amortization due on the employed member’ calamity loan assistance 2. The employer shall deduct the total balance ofthe loan from any company benefit due the memiber and shal remit the same in fulo SSS in case the member is separated from the company voluntary (eg, retirement or resignation oF involuntary (eg, termination of employment or cessation af operations ofthe company), 3. The employer shall repot to the SSS the effective date of separation from the company and the unpaid loan balance ofthe employed member, through the collection Is, the company benefit i insufiiet to ful repay the loan, 4, The employer shall require a new employee to secure from the SSS an updated statement of oustanding loan account, any 5. The employer shall deduct and remit to SSS any outstanding loan balance of new employees, |. RESPONSIBILITY OF MEMBER Members wo transfer employment shall submit to their new employer an updated statement of account of any outstanding loan balance with SSS and allow their employer to deduct rom thelr salary the cortespending amortization du, incuding any interesor penalty fr late emittance. J. DEDUCTION OF UNPAID LOAN FROM BENEFITS In case the member fails to immediately pay the oustanding balance, the arearagesiunpad loan, as well asthe interest and penalty thereon, shall be deducted from the benefis being claimed by the member, a8 flows: ‘© Foremployed member - ral benefits (otal disabiltyetrement/death) ‘© For seltemployed/ountary member - shortterm benefis (Sickness/Matemity/Partial Disabilly) oF final benefits (ota sabiltyretrementideatn) K. OTHER CONDITIONS 1. The member must personaly apt forthe Calamity Loan Assistance Program thru any SSS branch offices (Over-the-Counter) 2. For Overseas Flino Workers (OFWs)/Seatarers, the members must issue an Authorization Lette in favor oftheir authorized ‘representatives authorizing the later to fle thec Calamity Loan Assistance appicaton on their behal. 3, The member must submit a Barangay Certification certifying thatthe members are residents ofthe decared calamity area and were aflected by said calamity. ‘The member must cert the extent of damages, in peso equivalent, other homelpropery ‘This calamity loan must be fuly paid before the member can aval offutue calamity loans of SSS. ‘Other terms and conditions inthe existing salary loan guidelines not inconsistent withthe above provisions shall be applicable In tis program, 7. The member shall ott the Member Services Section ofthe nearest SSS branch office of any change in the following ‘2. address - thru SS Form E-4 fled over-the-counter (OTC) ». employer - thr a notice sent thru mail, fled OTC, or sent thru e-mait member _relaions@sss gov ph. The notice shall include the SS number, name and signature ofthe member. 8. Calamiy loan assistance check may be plckedup by the member/authorzed representative (for OFWiSeafarer member) win ten (10) working days at SSS Branch Office where the application is fled. After this period, the check wil be forwarded thru mailto the member's local maling adress. "RAS7S5, OTHERWISE KNOWN AS “TRUTH IN LENDING AGT” [ADISCLOSURE STATEMENT ON LOAN TRANSACTION SHALL BE ISSUED BY SSS TO THE MEMBERS UPON [APPROVAL OF THEIR CALAMITY LOAN ASSISTANCE PROGRAM APPLICATION.