Office of the President

NATIONAL HOUSING AUTHORITY

Elliptical Road, Diliman, Quezon City
AFP/PNP MILITARY HOUSING PROJECT

SWORN APPLICATION FORM

Date: ______________

THE GENERAL MANAGER

NHA, Diliman, Quezon City

SIR:

In accordance with NHA rules and regulations which I and my family agree to comply with faithfully, I hereby apply to purchase
(Please check):

Mode of Payments: Cash: _______ Installment: ______ With Equity: ______ No. of Installments: _______

A. APPLICANTS IDENTITY: (For female applicants/spouse, indicate maiden name)

NAME: PO1 Glorio Ortega Dumandan Jr. 205670 PNP____

(Rank) (First) (Middle) (Last) (Serial Number) (Br of Svc)
Home Address: Prk. 5, Brgy. Bala, Magsaysay, Davao del Sur_________
AFP/PNP ID NO.: ___12A100037_____ Issued on: ____January 10, 2012____ Issued at: _______Camp Crame, Quezon City___
Contact No.: ____0946-4489-631_____ TIN No.: ____293-563-940-000_____
Place & Date of Birth: ____Brgy. Bala, Magsaysay, Davao del Sur / May 16, 1987___ Unit/Office: ____11RPSB, PRO 11_____
Civil Status: ____Single____ Name of Spouse: ___N/A___

B. APPLICANTS FAMILY COMPOSITION:

NAME RELATION TO APPLICANT CIVIL STATUS AGE

Glorio Mara Dumandan_____ ________Father_______ __Married__ 57
Erlinda Ortega Dumandan___ _______Mother_______ __Married__ 58

Glorelyn Ortega Dumandan__ ________Sister________ __Single____ 30

_ Lynglor Dumandan Lakina____ ________Sister________ __Married__ 29
_ Glenn Boy Ortega Dumandan_ _______Brother_______ __Married__ 25
Eglorio Ortega Dumandan____ _______Brother_______ __Single____ 20

C. APPLICANT’S FAMILY INCOM PER MONTH: ____P14,834.00___

D. FAMILY PROPERTY REAL HOLDINGS: I certify that my spouse and I

( ) Do not own nor are holders of a contact to buy any lot/dwelling unit in the Philippines
( ) Have never availed of any government housing assistance nor violated Section 14 of RA 7279
( ) Do not own nor are holders of a contract to buy real property in the Philippines

I hereby certify that I am making this application for the sole purpose of acquiring a residential unit for my family and not as
DUMMY or AGENT of any other party.

Any false statement given by me hereinabove shall be sufficient cause for the cancellation of the award and contract that
maybe executed by NHA in my favor as a result of this application and the forfeiture of all payments that may have been
therefore without prejudice to any administrative, criminal or civil action that maybe brought by the NHA against me in
accordance with existing laws.

_________________________
(Signature of Applicant)

SUBSCRIBED AND SWORN to before me in ____________, Philippines, this ________ day of _____________
___2013___. AFFIANT, having exhibited to me his/her __Philippine National Police (PNP)___ ID as stated above.

NOTARY PUBLIC

Doc. No.: ________________

Page No.: ________________
Book No.: ________________
Series of 20_______________