WAH ERGONOMICS LOAN APPLICATION FORM with UNDERTAKING

EMPLOYEE INFORMATION
EMPLOYEE NUMBER Employee Name (Last Name, First Name, Middle Initial)
100655923 Torreno, John Weshly C.
ADDRESS Hire Date (mm/dd/yyyy) 10/01/2012
Blk. 5 Lot 3 San Lorenzo Ruiz Village Phase 1 Zone 1 Talisay City Negros Occidental 6115
WORK LOCATION (Bldg. & Floor) Contact No. 639773299165
One San Parq Square Bac 3 7th Floor Lacson St. Mandalagan Bacolod City 6100
REQUIREMENTS
1. Quotation for the WAH Ergonomics Furniture (Table, Office Chair, Laptop Stand, UPS, Back Support, Table
Lamps, Extension cords, WIFI extensions)
2. Official Receipt must be submitted within 30 days from date of loan release (Must contain name of
Concentrix employee (buyer), Purchase Date, Total Amount, Name of Vendor and TIN)
UNDERTAKING

1. That the loan acquired shall solely be for the purpose of purchasing of WAH Ergonomics Furniture such as:
Table, Office Chair, Laptop Stand, UPS, Back Support, Table Lamps, Extension cords, WIFI extensions

2. That I possess the qualifications and none of the disqualifications required under the WAH Ergonomics Loan
Program of the Company;

3.That I will secure a WAH Ergonomics Furniture to purchase in the amount of PHP 7,000;

4. The loan repayments will be deducted each payday from my salary within a period of six ( 6 ) months
to commence on the first payroll after the release of the loan;

5. The loan is interest free however I agree to shoulder the tax pertaining to the interest that should have been
imposed. For this purpose, I agree and authorize the Company to deduct not only the loan amortization but also
the withholding tax from the interest from my first payroll after the release of the loan.

6. That in the event that the loan was found to have been used for any purpose other than the declared
intention, any outstanding amount shall become immediately due and demandable which I shall pay within
such time as the Company may determine without prejudice to the application of disciplinary action in proper
cases. In case I fail to pay the outstanding amount within the period determined by the Company, I authorize
the Company to deduct in full the outstanding amount from my next payroll or from my final pay, as the case
may be.

7. That in case of resignation, termination or retirement, I hereby authorize the Company to deduct any
outstanding indebtedness from my final pay, bonuses, and other compensation payable to me upon my
resignation or separation from the Company.

8. That if any indebtedness shall remain after the deduction set forth in Clause 7 hereof, my liability under
this agreement shall continue to be in full force and effect and I shall immediately pay the balance without need
of further demand. The Company may not be stopped from taking the proper necessary actions to ensure full
payment of any and all such claims

9. That I will only be cleared of my accountabilities from the Company upon separation when the balance
from my WAH Ergonomics loan is be fully paid and settled.
10.That the venue of suits arising from this instrument shall be in proper courts of Makati City only.

11. That if payment is obtained through any legal action, any additional expenses, inclusive of litigation
expenses and judicial costs shall be charged to me as liquidated damages.
12. Except as otherwise provided in this document, this agreement may be modified, superseded, or voided
only upon the written and signed agreement of the Parties. Further, the physical destruction or loss of this
document shall not be construed as a modification or termination of the agreement contained herein.

13. I voluntary confirm that the facility extended by the Company is merely a loan and does not in any way
represent a requirement in any form, and that my availment of the same is purely voluntary. As the availment
of the loan is a voluntary act, I further agree to assume all risk that may be sustained by me and that I will
indemnify, hold harmless and defend any claim against the Company, its directors and officers, from any and all
claims or liability arising from any injury, loss or accidents that I may sustain or may suffer as a result of this
Agreement.

14. I hereby recognize that any act of misrepresentation, falsehood or fraud in relation to the WAH Furniture
quotation, my loan application, and this Agreement may result to a disciplinary action, including possible
termination of my employment.
15. I also hereby declare that the purchase and use of the WAH Furniture for which this loan is applied for is my
full responsibility.

I certify that I have read and understood this letter, and I accept the terms
of this document without any condition or reservation. I confirm my
agreement to the loan for the specific purpose mentioned above. I also
understand, that I have the obligation to pay back the loaned amount. As John Weshly C. Torreno
such, I hereby authorize Concentrix to deduct the loan payments from my
payroll account following the above-mentioned schedule or from my final
pay, in case my employment ends.

John Weshly Torreno 12/23/2020

Employee's Name Date
FOR HR USE ONLY
Approved Loan Amortization
APPROVALS
Approved Not Approved
• Submitted complete & valid
documents Reason:
• Reason for availment is valid

• Endorsed by Immediate Manager

Processed by: Approved by:

Signature over printed name Date Signature over printed Name