rn GSIS FINANCIAL ASSISTANCE LOAN (GFAL) (\o uss) i APPLICATION FOR TOP-UP OPTION ig PE GSIS 07092019.GFAL TOP-UP- REV 0 THIS APPLICATION SHALL NOT BE PROCESSED UNLESS COMPLETELY FILLED OUT. WARNING: Direct or indirect commission of fraud, collusion, falsification, misrepresentation of facts, or any other kind of anomaly in the ‘accomplishment of this fom, orn obtaining any benefit under this application, shall be subject fo administrative andior criminal action, 1 h to apply for the GSIS Financial Assistance Loan - TOP-UP LOAN in the amount of {amount in words) (Php ). PERSONAL DATA (Please printype) ‘Name of Member/Borrower Tast Name T FirstName Hidde Name Birthdate Biith Place BP Na, WallingiResidential Address Present SchoollOffice and Address [Telephone No. Gall Phone No. Ernail Address ‘Schoo! Details (for DepEd Employee): Division No. “Staton No. Employes No. UNDERTAKING In consideration of the loan granted under this application, | promise to pay the amount to the GOVERNMENT SERVICE INSURANCE SYSTEM (GSIS) in accordance with the terms and conditions printed at the back hereof which | have read and understood clearly and to which | bind myself to pay the required monthly amortization hereon through payroll deduction for which | hereby authorize my Treasurer / Disbursing / Collection Officer, to deduct the amount from my monthly salary. Further, the check representing proceeds from this fop up amount from the GSIS Financial Assistance Loan shall be made payable to the undersigned SIGNATURE OF MEMBERIBORROWER Position Titl/Designation ‘School and Division/Office Date Signed ‘TO BE FILLED OUT BY AGENCY This Office certifies that: (1) the above signature of the memberiborrower is authentic; (2) there is no pending administrative and/or criminal charge against the member/borrower; (3) the member/borrower is a permanent employee and regular premium-paying member of GSIS; (4) the member is not on leave of absence without pay; and (5) the member/borrower has an outstanding loan from lending institution/s which is being repaid through salary deduction For the Loan granted by virtue of this application, this office agrees to: (1) collect and remit immediately to GSIS the monthly installment due from said borrower, and (2) in case of his separation from the service, make final payments due him only after clearance is obtained from GSIS. Agency Authorized Officer (AAO) Date (Signature over Printed Name) ‘THIS APPLICATION IS NOT FOR SALE AND MAY BE REPRODUCED,‘TERMS AND CONDITIONS a. The "Top-Up" option shall be available to member-borrowers whose total outstanding loan obligations from lending institutions to be applied (or have been applied) under GFAL has not reached the maximum amount of Php500,000.00; provided, thatthe resulting net take home pay is not lower than the amount required under the General Appropriations’ Act (GAA) afterall required monthly obligations have been deducted, Below is the formula for computing the allowable “Top-Up” amount: (Gross Loan from Previous GFAL) + Top Up Amount < Php500,000.00 ‘The member-borrower has an option to choose an amount lower than the computed allowable top-up. The application for “Top-Up” shall be filed separately by the member-borrower. c. Amember-borrower with previously processed GFAL application may not apply for the "Top-Up" on the same month that the initial GFAL application was processed. However, first-time availees may apply for the GFAL and “Top-Up* option simultaneously, and the two shall be processed at the same time with only one (1) loan header created. d. The qualification of the member-borrower for the "Top-Up" shall be evaluated based on the same conditions laid down under Section IVC ("Qualified Loan Borrowers”) of PPG No. 338-19 (GFAL Il); hence, the borrower: (1) Must be an active regular or special member (with an existing Memorandum of Agreement under PPG No. 234~13 which allow the grant of Salary and other loan privileges to Special Members) of the GSIS with permanent status of employment. Regular active members must have at least three (3) years of periods with paid premiums (PPP); (2) Has no pending administrative case andior criminal charge; Provided, however, that if the pending case or charge is filed by an accredited lending institution due to the Borrower's non-payment of histher loan obligations as a result of the prioritization of GSIS and Home Development Mutual Fund (HOMF) loan payments, the Borrower shall remain eligible, subject to the submission of documentary proof stated under Section IV.D of PPG No. 338-19; (3) Is not on Leave Without Pay (LWOP) atthe time of availment; (4) Has a previous or simultaneous application for GFAL; and (5) Has no due and demandable loan accountis with the GSIS. fe. There shall be no fees to be attached to the additional or top up loan amount applied by the member-borrower, {, The following shall be deducted from the new or recomputed loan after availment of the “Top-Up” option: + Interest in Advance; © Advance Redemption Insurance premium; and © Outstanding balance from existing GFAL account (if any), computed as of date of granting ofthe top-up amount The deduction of outstanding balance of the existing GFAL account shall not resut in the full payment of the initial GFAL loan. The Purpose of the said decluction is to determine the top up amount only. 9. The proceeds of the top-up amount shall be payable directly to the member-borrower through check. fh. The application for “Top-Up” amount can be availed of only once during the implementation period of GFAL. i. The top-up amount shall be subject to the same interest rate, loan term and other terms and conditions such as but net limited to monthly amortization and its due date, payment mechanism, penalty for arrearages, automatic deduction of arrearages and default provision of the GFAL application being applied or already existing, | confirm that ! have read and fully understood the GFAL ~ Top-Up Option Terms and Conditions and undertake to comply with them. Furthermore, | hereby authorize the GSIS, through my employer (goverment agency), to deduct from my terminal leave benefits any remaining outstanding loan obligations | may have with the GSIS upon my separation or retirement. I understand that the remittance thereof by my employer to the GSIS shall first be undertaken before the issuance of a GSIS clearance for the release of my remaining terminal leave benefits, ifany. | confirm my understanding of the Privacy Poliey of the GSIS pursuant fo the requirements of Republic Act (R.A.) No. 10173, otherwise known as the Data Privacy Act, and consent to the manner of collection, use, access, disclosure and processing of my personal and ‘sensitive personal data by the GSIS. Finally, pursuant to RA. No, 9510, otherwise known as the "Credit Information System Act’, and its Implementing Rules and Reguiations (IRR), I hereby acknowledge and consent to: 1) the regular submission and disclosure of my basic credit data and updates thereon to the Credit Information Corporation (CIC); and 2) the sharing of my basic credit data with lenders authorized by the CIC, and credit reporting agencies and outsourced entities duly accredited by the CIC, subject fo the provisions of R.A. No. 9510, its IRR and other relevant laws ‘and regulations. MEMBER/BORROWER DATE SIGNED (Signature over Printed Name) "Tax Identification Number (TIN)