Republic of the Philippines SOCIAL SECURITY SYSTEM MUP-01263 (04.2016) LOAN RESTRUCTURING APPLICATION N 'PLEASE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK OF THE FORM ANO THE ATTACHED TERMS AND CONDITIONS BEFORE [ACCOMPLISHING THIS FORM PRINT ALL INFORMATION IN CAPITAL LETTERS ANDO USE BLACK INK ONLY. PARTI-TO BE FILLED OUT BY THE FILER TX NENBER BORROWER DATA LEitiitititiititipiittititipptiitiitit Litt rT titi faACRGAOGRESS POSTAL CORR ENPCOVER NAME [EWPLOVER ADDRESS POSTAL CODE} [ODE OF AVATMENT Ti FarPayment Dinsainent (Reterto he attached Statement of Loan Balances for payment em [in months) FILER DATA (FOR DEATH BENEFIT CLAIM Rane TREY FETE, OE TPR CERTIFICATION AND UNDERTARNG a | fan of is application are tue and eorect. 2 lunconstonaly agree to the TERMS AND CONDITIONS ofthe SSS Loan Restructuring Program attaches otis apoieation 3, also cery that my cazacty to pay the loans sated inthe attached Statement of Loan Balanoes for Loan Restructuring Program has been impare by ‘he calamayasaster that occured in my area which esse to incutence of terest and penltes of he sai loans. 4, Incase that itis proven that! have given false information or misepresertaton in tis document crn ay ater documents submited in connection wit my Loan Restructuring Applicaton | undertake to pay tbe outstanding balance including the condoned penal FICER'S PRINTED NAE TITERS SIGNATURE DATE PARTI TO BE FILLED OUTBY SSS) [IS CARDS OR DOCUMENTIS PRESENTED [DOCOENTIS SUBMITTED. Qumoiss 0 cars D1 Two vals, one w! photo and both wi signature 1 statement of Loan Balances atidavitot Residency Dotner primary iorsocument. special Power of atomey JRECEIVED AND ENCODED BY 'SIGHATURE OVER PRINTED WANE DATE ETE ‘SIGNATURE OVER PRINTED NAN DATES TE, Periorats Here woserssnsnsvenrenresrenresstaets ‘Republic ofthe Philippines Wy SOCIAL SECURITY SYSTEM 4 LOAN RESTRUCTURING APPLICATION MUP-07263 (04.2016) ACKNOWLEDGEMENT STUB [5s NOVEERCONNON REFERENCENO ran [NANE OTR RST TE TOTES aT Pititiitityt JRECENED BY ‘SIGNATURE OVER PRINTED NANE POSTON TITLE DATES TIME ‘585 BRANCHINSTRUCTIONS 1. Secure updated Statement of Loan Balances for Loan Restructuring Program (2 copies) fom the nearest SSS branch or foreign offce pr to ‘submission of this form 2. Accomplish an Mfdavit of Residency altestng residencnivork address in a covered calamiy ates when the calamiylisaster happened (except for ‘member borrower with Calamity Laan or Salary Loan Early Renewal Program (SLERP) and Death Benet fer), Fouts form in one (1) omy ‘Aways inaeate "N/A" or°Not Appicabl’ the required data snot appcabe. ‘Aways af nial on al erasuresateratons on tis frm. If member borower is fling this form, present orginal copy of vad identfeaton cardlGocuments, Refer to “List of Fier's Vaid Isenfeation (1) CardsiDecuments* below Ia representative i ing tis form, submit the fobowing Special Power of Atoney (SPA) aginal copy 1 Photocopies of two 2) val! identfeation cards each ofthe memberborawer andthe filer, at least ane (1) wih photo ang both wih sgnstre present orginal Refer to List of Fler Val dentition ID) CardsfDocumens” below | Submit thi form to the nearest SSS branch oF foreign oft withthe Staloment of Loan Balances for Loan Restucturing Program signed in the “Contre potion a the notarized Ata of Resisency if appicabi) 9. For Death, Total Disbity, or Retroment (DDR) benef fer who wil ava ofthe Loan Restructuring Program, submit ths frm and Statement of Loan Balances for Loan Restructuring Program togeter with the DDR clam apptcaton. LIST OF FILER’S VALID IDENTIFICATION (ID) CARDS/DOCUMENTS ‘SSS LOAN RESTRUCTURING PROGRAM Present the orignal copy of any one (1) of te primary ID cardsidocunents i em Ao wo (2) secondary ID cardsdocuments in Ham B atleast one (1) lt photo and both wih signature ‘Al ientifcaton (1) cares andlor document wth English translaton sue by foreign government ae acceptable fled by Attomey.in-Fact of Member-Borrower, present te folowing ‘8. Original copy of any two (2) a he Attorney.n-Facr's valid dertiieaton carts or documents, t least on (1 with photo and both wth signate and . Onginal copy of any two (2) of the Member-dorcuers valid idenifeston cards or dacuments, at east one (1) with photo and bath wih signature A. Primary ID Cards/Documents 41. Social Security (88) Card 4. Passport 2. Unified Must-Purpose 1D (UMID) Cac 5. Professional Regulation Commission (PRC) cad 3. Drivers License 5 Seaman's Book (Seafarers Identfcation & Record Book) B. Secondary ID Cards/Documents 1 Alen Ceiicate of Registration 10-10 cara issue by Local Government Unis (LGUs) (eg, Barangay! 2 Certificate of Licensure/Quaifcation Decuments fom Maritime Masciattyiciy) Inausty Autronty 1110 cara issue by professional astocation recognized by PRC: 3. Certticate of Muslim Filpino Tribal Mfliaton issued by National +12. Marriage CorracuMariage Certicate ‘Commission on Musi Fiipnos 13. Overseas Worker Wetare Adminstration (OWA) car 4 Company 10 Cara "4 Philippine Heat Insurance Corpration (PHIC) ID cars Frearm Licnse card issued ty Pippine National Poice 18. Police Clearance or NBI Cearance 15 Fistworkers License issued by Bureau of Fisheries and 16. Postal ID card ‘Aquatc Resoutees (BFAR) 17, Schoo! 10 card 7. Government Senice insurance System (6S!S) cardMember's 18, Seafarers Regstraton Cetficate isu by Piopine Overseas RecordiCervicate of Membership. Employment Administration 2 Heath or Mecca! cars 18, Senor Citzen card Home Development Mutual Fund (PagBIG) Members Data 20, Taxpaye’'settication Number (TIN) card Fam 21, Vole’ deniicaton car or Voters AtidavtsCericate of Registration 'A.3765, OTHERWISE KNOWN AS “TRUTH IN LENDING ACT" |A DISCLOSURE STATEMENT ON LOAN TRANSACTION SHALL BE ISSUED BY SSS TO THE MEMBER-BORROWER UPON APPROVAL OF HISIER, LOAN RESTRUCTURING APPLICATION. WARNING |ANY PERSON WHO MAKES ANY FALSE STATEMENT IN THIS APPLICATION OR SUBMITS ANY FALSIFIED DOCUMENT IN CONNECTION wiTH THE} JAPPLICATION FOR LOAN RESTRUCTURING PROGRAM SHALL BE LIABLE CRIMINALLY UNDER SECTION 28 OF R.A. 8282 OR UNDER PERTINENT] PROVISION OF THE REVISED PENAL CODE OF THE PHILIPPINES. REMINDER Verification of status may be made thu the SSS Website at www ss gov ph or contac ou Call Center at 920-5446 up o 5 or 917-7777TERMS & CONDITIONS FOR LOAN RESTRUCTURING PROGRAM (SSC Resolution Nos. 424-s.2015 dated 29 May 2015, 795-s.2015 dated 4 November 2015, 217-5.2016 dated 4 April 2016 ‘and 258-¢.2016 dated 18 April 2016) ‘A. ELIGIBILITY REQUIREMENTS 1 Allmember-borrowers with any ofthe folowing past due shor-erm loans are eligible forte program, ‘Calamity Loan Emergency Loan Vocationav Technical Course Loans Salary Loan Eary Renewal Program (SLERP) Educational Loan (8) Yak Loans Salary Loan Study Now Pay Later Plan Investments incentive Loan 2. For past due eharttorm loons except Calamity Loan and SLERP, member-boraner must have previously Ivedvorked ina calamiyideaster ‘ticken area as declared bythe National Dieter Rick Reduction and Management Counc! (NORRMC) othe National Goverment 3. The oustanding shot term fons must be pas de fora period ofa east sx (6) months aso he fist day of restucturng period 4 The member-borower: 47 Must be ling or working in calamityiisaster declared area as of disaster date or as of application date ‘addres ofthe member borrower. 42. Must be under 65 years old tthe ond ofthe instalment term, : 43 Has not been grand any final benefit ie tal permanent disabity o retirement. 44 Has nol been disqualified due to rau comsitted agains the SSS 5 Member-bortowors with final benefit ciaim application (Death, Total Dsablly, Retirement) whose contingency date is on or before the last day of ‘he avaliment period ofthe restructuring program are eigbe for the program. Said thal Benet claim must be hled ihn the availment period 8. AREAS COVERED Covered areas are those declared by NORRMC or the National Government as under the state of calamity due othe folowing calamitisisisasors: lung” shall refer tothe home 1. Ondoy (2009) 58. Labuyo 2019) 8. Bohol and Cebu Earinquake (2013) 13. Mario 2014) 2, Sendong (2011) 6. Maring (2013) 10. Yolanda (2013) 14, Ruby (2014) 3, Pedring and Quel (2012) 7, Sant (2013) 11. Agaton (2013) 15. Soniang (2014) 4. Pablo (2012) {8 Armed Confit in Zamboanga (2013) 12. Glenda 2014) 18. Lando 2015) 17, Nona (2018) ©. AVAILMENT PERIOD ‘Loan Resiructunng Program may be availed fr one (1) year rom Apri 28, 2016 to Api 27,2017 'D. RESTRUCTURED LOAN AMOUNT AND PAYMENT TERM, The principal and interests of al past due short-term loans of the member-borower shal be consolidated into one Restucured Loan (RL) payable ether in ful ornstalment payment 1. Full payment payable within 30 days ftom the approval of restructuring appcation 2. Instalment payment -payabo in equal monty amortization over applicable term based on RL range below. el RANE, [APPLICABLE TERM. {Sum of Principal & Interest) ~ P 2,000.00 to 18,000.00 2 months 18,000.01 19 P'36,000.00 26 months 136,000.01 1 F 64,000.00 38 months 88,000.01 19 F 72,000.00 “48 months ‘More than P 72,000.00, (60 months “For RLi ameunt ess han P 200000 pefeved terms FULL PAYMENT ‘However, the member-borower may ect his prefered payment arm but nto exceed fe (8) years. E, INTEREST RATE AND PENALTY 1. For instalment torm, RL shall be subject o interest rate of 3% per annum computed on a diminishing principal balance over the applicable payment term 2, A penalty of 0.5% per month shal be charged aginst the amorization due for every month unpaid dng the approved erm F. CONDITIONAL CONDONATION AND INTEREST RATE AFTER TERM EXPIRY Fenales shall be condoned ato ful payment of RL! win ts approved tar. The balance of RL! shouldbe zero atthe end ofthe term. Otherwise, ‘he unpaid principal of RLI and the poportonate balance of condonable penaly shall become art of new principal under Restructured Loan 2 {(RL2) and shall hencefrin be charged a 103 interest per annum until fuly paid. The unpaid inerests and penalties of RL! shall thewise be transferred to RL. DUE DATES AND MANNER OF PAYMENT 41, Monthy instaiment shal be due for payment every 10th day ofthe month folowing the amertizaton math. Amortzaton shall star on the month immediate folowing the approval date of he Restructured Loan Example: > Restuctured Loan Approve! Month: APRIL > fstamortiztion mont MAY > tatintaliment amortzaton is due on JUNE 10 2, Payment shall be made trough ary SSS branch wit tolering facts or authorized cllecton agent ofthe SSS. H. OTHER CONDITIONS 1 While the restructured loan is existing oF oustanding, the member-borower cannot avail of ather SSS short-term loan programs inclung Educational Assistance Loan Program, “The member-borrower may aval othe SSS short-term loan programs after sk (6) months from the date of ul payment ofthe Restructure Loan, “The member-borrower cannct aval of any future condonationestucuring programs of SSS once this esrturing application is approved During the tm of the restructured loan, the member-borrower shal nobly the nearest SSS branch hshher updated contact information ths ‘accomplishment of Member Oata Change Request (SS Form Ea) 5. Incase of member-borower's death, otal dsabily, or rerement, the total oan obligation or any unpaid amount of he loan as wel as the intrest ‘and penaly thereon, i an, shal be deductod from the tna Deets