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DATE RECEIVED </div> <div class='ff5' style='left: 64.65em; font-size: 7.37em; top: 7.75em;' > RECEIVED BY </div> <div class='ff5' style='left: 21.46em; font-size: 8.66em; top: 10.59em; '> PART I EMPLOYEE TO FILL IN ALL ITEMS </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; top: 14.56em;' > SS NUMBER </div> <div class='ff5' style='left: 26.16em; font-size: 7.37em; top: 14.56em; '> LOAN TYPE </div> <div class='ff5' style='left: 53.73em; font-size: 7.37em; top: 14.56em; '> TIN </div> <div class='ff5' style='left: 38.95em; font-size: 7.37em; top: 20.24em; '> ADDRESS </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; top: 20.24em;' > NAME OF MEMBER </div> <div class='ff3' style='left: 44.61em; font-size: 6.67em; top: 26.41em; '> (NO. &amp; STREET) </div> <div class='ff3' style='left: 57.78em; font-size: 6.67em; top: 26.41em; '> (BARANGAY) </div> <div class='ff3' style='left: 68.49em; font-size: 6.67em; top: 26.41em; '> (TOWN/DISTRICT) </div> <div class='ff3' style='left: 6.61em; font-size: 6.67em; top: 32.14em;' > (FIRST NAME) </div> <div class='ff3' style='left: 18.17em; font-size: 6.67em; top: 32.14em; '> (MIDDLE NAME) </div> <div class='ff3' style='left: 30.83em; font-size: 6.67em; top: 32.14em; '> (LAST NAME) </div> <div class='ff3' style='left: 44.61em; font-size: 6.67em; top: 32.16em; '> (CITY/PROVINCE) </div> <div class='ff5' style='left: 64.43em; font-size: 7.37em; top: 25.74em; '>

POSTAL CODE </div> <div class='ff5' style='left: 21.29em; font-size: 8.66em; top: 26.35em; '> PART II EMPLOYER TO FILL IN ALL ITEMS </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; word-spacing: 0.01em; top: 33.10em;'> EMPLOYER S ID NUMBER </div> <div class='ff5' style='left: 38.95em; font-size: 7.37em; top: 33.10em; '> ADDRESS </div> <div class='ff3' style='left: 44.61em; font-size: 6.67em; top: 40.78em; '> (NO. &amp; STREET) </div> <div class='ff3' style='left: 57.78em; font-size: 6.67em; top: 40.78em; '> (BARANGAY) </div> <div class='ff3' style='left: 68.49em; font-size: 6.67em; top: 40.78em; '> (TOWN/DISTRICT) </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; word-spacing: 0.01em; top: 39.00em;'> EMPLOYER S NAME </div> <div class='ff3' style='left: 44.61em; font-size: 6.67em; top: 47.03em; '> (CITY/PROVINCE) </div> <div class='ff5' style='left: 64.43em; font-size: 7.37em; top: 39.00em; '> POSTAL CODE </div> <div class='ff5' style='left: 27.33em; font-size: 8.66em; top: 52.47em; '> FOR SSS USE ONLY </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; top: 63.80em;' > DOCUMENTS PRESENTED </div> <div class='ff5' style='left: 38.94em; font-size: 7.37em; word-spacing: 0.01em; top: 63.80em;'> ENCODED BY </div> <div class='ff9' style='left: 48.55em; font-size: 5.23em; top: 104.61em ;'> PERFORATE HERE </div> <div class='ff5' style='left: 48.77em; font-size: 8.66em; top: 72.35em; '> FOR SSS USE ONLY </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; top: 85.08em;' >

SSS NUMBER </div> <div class='ff5' style='left: 25.60em; font-size: 7.37em; top: 85.08em; '> EMPLOYER S ID NUMBER </div> <div class='ff5' style='left: 3.65em; font-size: 7.37em; top: 90.97em;' > NAME OF MEMBER </div> <div class='ff3' style='left: 6.61em; font-size: 6.67em; top: 104.45em; '> (FIRST NAME) </div> <div class='ff3' style='left: 23.14em; font-size: 6.67em; top: 104.45em ;'> (MIDDLE NAME) </div> <div class='ff3' style='left: 40.76em; font-size: 6.67em; top: 104.45em ;'> (LAST NAME) </div> <div class='ff5' style='left: 54.46em; font-size: 7.37em; top: 87.12em; '> DATE RECEIVED </div> <div class='ff5' style='left: 65.02em; font-size: 7.37em; top: 87.12em; '> RECEIVED BY </div> <div class='ff5' style='left: 28.50em; font-size: 7.37em; top: 17.44em; '> SALARY </div> <div class='ff5' style='left: 36.67em; font-size: 7.37em; top: 17.47em; '> CALAMITY </div> <div class='ff5' style='left: 45.61em; font-size: 7.37em; top: 17.47em; '> EMERGENCY </div> <div class='ff0' style='left: 10.76em; font-size: 10.20em; top: 4.62em; '> ISL-101 </div> <div class='ff3' style='left: 16.17em; font-size: 7.10em; top: 8.75em;' > REV 01-2006 </div> <div class='ff3' style='left: 28.78em; font-size: 8.01em; top: 3.14em;' > Republic of the Philippines </div> <div class='ff5' style='left: 24.98em; font-size: 8.66em; top: 4.05em;' > SOCIAL SECURITY SYSTEM </div> <div class='ff5' style='left: 13.02em; font-size: 13.38em; top: 3.50em; '>

MEMBER LOAN APPLICATION </div> <div class='ff5' style='left: 31.03em; font-size: 6.07em; word-spacing: 0.01em; top: 11.18em;'> PLEASE READ INSTRUCTIONS AT THE BACK.<span class='ib' style='width: 0 .61em;'> </span>PRINT ALL </div> <div class='ff5' style='left: 29.23em; font-size: 6.07em; word-spacing: 0.01em; top: 12.43em;'> INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY </div> <div class='ff8' style='left: 21.62em; font-size: 2.83em; top: 46.10em; '> </div> <div class='ff8' style='left: 56.72em; font-size: 2.83em; top: 46.10em; '> </div> <div class='ff8' style='left: 154.98em; font-size: 2.83em; top: 46.10em ;'> </div> <div class='ff8' style='left: 171.36em; font-size: 2.83em; top: 46.10em ;'> </div> <div class='ff8' style='left: 28.64em; font-size: 2.83em; top: 94.01em; '> </div> <div class='ff8' style='left: 63.74em; font-size: 2.83em; top: 94.01em; '> </div> <div class='ff8' style='left: 70.75em; font-size: 2.83em; top: 94.01em; '> </div> <p class='pc ff5' style='left: 4.26em; font-size: 9.49em; line-height: 1.23em; top: 35.15em;'> WE AGREE TO THE TERMS AND CONDITIONS OF THIS LOAN AS ENUMERATED<br /> AT THE BACK OF THIS FORM.<br /> FURTHER, WE CERTIFY THAT ALL INFORMATION WE HAVE GIVEN<br /> ARE TRUE AND CORRECT.<br /> </p> <div class='ff5' style='left: 66.29em; font-size: 6.90em; top: 60.93em; '> RIGHT THUMBMARK </div> <div class='ff3' style='left: 65.25em; font-size: 7.10em; top: 60.44em; '> (IF CANNOT SIGN) </div> <p class='pc ff3' style='left: 3.76em; font-size: 7.10em; line-height: 1.25em; top: 59.12em;'> ___________________________________________________<br /> SIGNATURE OF EMPLOYER S AUTHORIZED REPRESENTATIVE<br /> (OVER PRINTED NAME)<br />

</p> <div class='ff3' style='left: 44.36em; font-size: 7.10em; top: 59.25em; '> _________________________________ </div> <div class='ff3' style='left: 47.40em; font-size: 7.10em; top: 60.50em; '> SIGNATURE OF APPLICANT </div> <div class='ff3' style='left: 34.04em; font-size: 7.10em; top: 59.25em; '> _______________ </div> <div class='ff3' style='left: 35.06em; font-size: 7.10em; top: 60.49em; '> DATE SIGNED </div> <p class='pl ff5' style='left: 6.21em; font-size: 7.37em; line-height: 2.70em; top: 65.53em;'> SOCIAL SECURITY CARD<br /> E-6 ACKNOWLEDGEMENT RECEIPT AND TWO VALID IDs<br /> OTHERS:<br /> </p> <p class='pl ff5' style='left: 6.21em; font-size: 7.37em; line-height: 2.70em; top: 65.53em;'> SOCIAL SECURITY CARD<br /> E-6 ACKNOWLEDGEMENT RECEIPT AND TWO VALID IDs<br /> OTHERS:<br /> </p> <div class='ff3' style='left: 40.79em; font-size: 7.10em; top: 73.48em; '> _______________________________________ </div> <div class='ff3' style='left: 43.88em; font-size: 7.10em; top: 74.74em; '> SIGNATURE OVER PRINTED NAME </div> <div class='ff3' style='left: 64.78em; font-size: 7.10em; top: 73.52em; '> _________________ </div> <div class='ff3' style='left: 68.34em; font-size: 7.10em; top: 74.77em; '> DATE </div> <div class='ff5' style='left: 18.75em; font-size: 6.90em; top: 82.92em; '> SOCIAL SECURITY SYSTEM </div> <div class='ff5' style='left: 10.59em; font-size: 9.49em; word-spacing: 0.01em; top: 61.22em;'> ACKNOWLEDGEMENT RECEIPT </div> <div class='ff5' style='left: 17.41em; font-size: 6.90em; top: 85.84em; '> SSS FORM ISL-101 (REV 01-2006) </div>

<div class='ff5' style='left: 17.33em; font-size: 6.90em; word-spacing: 0.01em; top: 88.75em;'> TO BE FILLED UP BY APPLICANT </div> <p class='pj ff5' style='left: 42.30em; word-spacing: -0.05em; font-siz e: 6.90em; line-height: 1.23em; top: 81.85em; width: 34.61em;'> <span class='nw' >VERIFICATION OF STATUS WILL BE ENTERTAINED AFTER 3< /span> <span class='nw' >WORKING DAYS FROM RECEIPT OF APPLICATION BY SSS.</span> <span class='nw' >PLEASE PRESENT THIS RECEIPT WHEN INQUIRING ABOUT</span> <span class='nw' >STATUS OF APPLICATION OR YOU MAY TEXT SSS AND KEY IN</span> <span class='jbr' ></span> </p> <div class='ff5' style='left: 42.30em; font-size: 6.90em; word-spacing: 0.13em; top: 86.87em;'> SSS S<span style='left: 0.02em; word-spacing: 0.14em; margin-right: 0 .02em;'>ALSTAT SSS NUMBER BIRTHDAY (MMDD</span>YYYY<span style='word-spacing: 0 .16em;'>) AND SEND</span> </div> <div class='ff5' style='left: 42.30em; font-size: 6.90em; top: 88.12em; '> TO 288 (SMART SUBSCRIBERS) OR 2931 (GLOBE SUBSCRIBERS). </div> <div class='ff8' style='left: 77.77em; font-size: 2.83em; top: 229.38em ;'> </div> <div class='ff8' style='left: 112.87em; font-size: 2.83em; top: 229.38e m;'> </div> <div class='ff8' style='left: 119.89em; font-size: 2.83em; top: 229.38e m;'> </div> <div class='ff8' style='left: 77.77em; font-size: 2.83em; top: 229.38em ;'> </div> <div class='ff8' style='left: 112.87em; font-size: 2.83em; top: 229.38e m;'> </div> <div class='ff8' style='left: 119.89em; font-size: 2.83em; top: 229.38e m;'> </div> <div class='ff3' style='left: 118.26em; font-size: 4.43em; top: 159.71e m;'> MJVF14 </div> <div class='ff8' style='left: 21.62em; font-size: 2.83em; top: 229.51em ;'> </div> <div class='ff8' style='left: 56.72em; font-size: 2.83em; top: 229.51em ;'> </div> <div class='ff1' style='left: 5.54em; font-size: 4.79em; top: 18.97em;'

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