{ARMED FORCES ANO POLICE MUTUAL BENEFIT ASSOCIATION, NC. ‘Col Bonny Serrano Road cor E. Delos Santos Avenue, Camp Aguinaldo, Quezon City Cac No, (02) 822. MOAI (224) Web: wo cor.ph hf Sretatgeemnaon remo @ArBOm—Aybre AI.” |Ambayec “rareh eenson Oe Dae Tone oan Tipe Relate of Gsim/ Senet / Refund Croucr —Cexpanoeosauarr | CiForFickup Head omce OmpalBrench__ 0 eliphone Deouity yea Gordepost___OaTIa/Act No SRA cy Cloruens Ti (Piease put a check markin the box, Ifyou agree) Any future unclaimed Refunds or any other clabm EMERGIIY pertiment to loan shall automatically be deposited in the ATM account ofthe claimant ae Topiaton Type Toan Parpare Drew Clreneval Lersonal Dlbusiness Dlothers ‘amount n Words ‘AmountiaFawres oan fm Farman ade ween | C)povot DoireceParment ros oates checks LAST NAME: IMIDDLE NAME: FIRST NAME: EXT NAME: UR, $8. rr [DATE OF BIRTH (DD/MMIYYE: AGE: RANK SERIAL/BADGE/ACCT NO: [RETIREMENT DATE: Bos: UNIT ASSTGNMENT. [URITADDRESS: [CELL PHONE Wi PRILSYS NO. (PSN) EMAIL ADDRESS: PRESENT ADDRESS PERMANENT ADDRESS: Pursuant to Republic Act No. 9510 creating the Crecit Information Corporation (CC), its Implementing Rules and Regulations (IRR), and various Circulars, the AFPMBAl is mandated to submit the borrower's basic credit data as defined by law, as wel as any regular updates or carrectons thereof, to the CIC for consolidation and disclesure as may be authorized by the CIC. Consequently, the basic credit data may be shared with other lenders and ‘other credit reporting agencies duly authorized by the CIC, forthe purpose of establishing the borrower's creditworthiness. For more information, please vist the website ar wiww.creditinfo.gouph. ‘Are you 3 Close Family Member (legitimate or common-law: spouse, parent, child, brother, sister, grandparent, grandchild, parent-in-law, son/daughter.i-law, brother/sisterin-law, grandparentin-law, and grandchildivlaw) of any of the AFPMBAI Board of Trustees, corporate officers, (Chairman, Vice-Chairman, President and CEO, Corporate Secretary, Treasurer, Senior Vice-Presidents) and key management personnel (Heats of Sales and Operations Group, Corporate Services Group, Executive Services, Finance, Internal Audit, Area and Branch Operations, Legal, information Technology, Admin, Real state, Human Resource, Insurance Sales, and Marketing)? Lno 1 yesarves,incicate the name of your related party) AFPMBAI upholds an individuals data privacy rights and observes that ll personal information, sense personal information and privileged information collected andto be collected are processed or recorded, managed, organized, stored, updated, retrieved, consolidated, used, blocked, and erased according tothe Data Privay At of 2012 (RA 10173), ts Implementing Rules and Regulations (RA), and various Circulars unde the prinipies oF transparency, legitimate purpose, and proportionality. | hereby give my consent to the processing, sharing, and/or transferring of my personal data relating to my accaunt/s, without notice, to AFPMBAl, Its service providers and entities or third parties having authority or right to such disclosure of information as in the case of regulatory agencies, {governmental or otherwise, which have required such disclosure from AFPMBAI, also to enable AFPMIBAI to service my accounts, to provide al existing features and future enhancements thereto, and to aval other AFPMBAI products, services, facilites and channels as the AFPMBAI deems necessary. ‘agree to hold AFPMBAY, its affiliates, subsidiaries and third party service providers free and harmless from any liability arising from or in connection with the consent herein given, "AUTHORIZED REPRESENTATIVE BORROWER'S SIGNATURE “SIGNATURE OVER PRINTED NAME ‘Lupmp TLAB0D Acad a: Comalerto: Loin Baltion Policy /Basic Cert. Nr Optional Insurance ‘SPL (Kawal Kalinga) Salary Loan. Face Amount, Optional Policy Loan ‘Appliance Loan MEDAL ‘Amt Loan Premium fc okey Loan emi an Cotimity in tee Oe Age, Members ay Los MEDAL ype ton mn fe revnrem Members wean Ip Needy E56 Poe tan weer Te i one Sour toan = }1. Salary/Expanded Salary Loan: the borrower must have an active Permanent Insurance and/or E-56 with AFPMBAI which is enforced for at least 1 month at the time of application. 2. MEDAL: the borrower should have existing Basic Insurance, Permanent/E-S6 Insurance or SGTI coverage. 3. The borrower must have a good credit record as determined by any credit bureau/facility, All his/her accounts should be current and have NO ARREARS. 4.The borrower should have a NET TAKE HOME PAY as required by his branch of service/bureau after deducting the monthly amortization of Salary Loan/MEDAL. '5.One Salary Loan and 1 MEDAL per borrower is allowed regardless on the number of policies held but not to exceed the aggregate face amount of his/her insurance, LOANTYFE ‘AMOUNT [INTEREST] TERM RENEWAL OTHER CONDITIONS fay emovne na F. Silery MEDAL + for rettng Poly exconding cach value] 6% | 24 mos.max [ME avmentofat ast MoM comes, the. payent tam lof the policy pmorszation Jshall be reckoned on the retirement date or on the maturity pacconodend below] 6k 12 mos.max _lafter payment of 6 equal monthiylof the longest policy in effect, Eauity Above —Toro0eO ta) — Jamon max amortization whichever comes fst. 60,000.00 on > 60,000.00 and below] 8% 24 mos ls [Above —P—60,000 05" can After payment of 6 consecutivel2, Salary/MEDAL : the frst aan 100,000.00 es * Jequal monthly amortization monthly amortization for frst time per OOOO ag {60 mos. loan shall be due on the 3rd 300,000.00 month from date of loan release. (ter payment of 6 consecutive MEDAL 7300/000 00 max | mesa M% lequat monthly amortzations [25% Tum sum not Jess than 1 year to} Expanded Salary Tescoeding PAM retirement 1. Salary Loan : SLRI and premium payment due are as follows : [Term in months 6 [2]el~@]«,s%)] 2] @)] 3] 0 Rate per P1,000.00 333 | 500 | 795 [1048 1298] 1575 | 1893 | 22.20 | 2525 | 28.40 2. MEDAL: Credit Redemption Insurance (CRI) premium and payment due are as follows [Term in months Ce EE Rate per P1,000.00 333 | 437 | 5.00 | 795 | 10.08 | 12.98 [15.75 3.Health Declaration to support SLRI/CRI is required for loans above P200,000.00 and shall be incontestable after being enforced for 1 ‘year from the date of effectivity. 4.{F loan is fully paid or renewed prior to its maturity, SLRI/CRI rebate is made except for loans with remaining term of ess than one year, 5.In case of borrower's death, if loan is a) updated - the outstanding balance should be considered fully paid; b) with arrears - SLRI/CRI should only cover the theoretical balance (penalties, interest, arrearages not included). Any unpaid balances should be deducted from his/her Death Benefits; c) is dormant/expired term - loan covered by SLRI/CR. ct or Indirect commission of fraud, collusion, falsification, misrepresentation of facts or any other kind of anomaly in the accomplishment of this form, or in obtaining any benefit or payment under this application that resulted to damage and/or financial loss to AFPMBAI shall be subject to administrative, civil and/or criminal action/liabilities. SERVICE RECORD CLEARANCE ‘THis IS TO CERTIFY that subject personnel is a bonafide 8IMP | THIS IS TO CERTIFY that subject personnel has NO PENDING CASE. personnel on a permanent status. Director, Directorate for Personnel and Records Management Chief, Legal Service Office FINANCE ‘THis [STO CERTIFY that subject personnel has @ NET Take Home Pay of P and P available for loan payment. Chie, Finance Service OfficeFor value received, | promise to pay to the order ofthe Armed Forces and Police Mutual Benelit Assocation, Inc (AFPMBA\), the principal amount and interest, Including the penalties, charges and ethers costs any, a follows PRINCIPAL LOAN AMOUNT LOAN TERM, Move or payment: — C)payrott Deauetion Irenesr RATE MONTHLY AMORTIZATION loirect payment ‘oral omucaTion irost nated checks {ato agree to pay the amount due incuang additonal interest at the rate abows stated and al fees and charge on all monthly amortizatons that are defaulted or ‘layed, be ¥ my own overight oF not, without further need of notice or demand. Any unpaid amortuation due shall boar an addonal ingeert fr delayed payment ‘Acceptance by AFPMBAI ors amigns of ny amount fter my obligation hes become due In secordance herewith shal ot be carakered at extending the time for Payment or a a modification or novation of any ofthe conditions hereok ‘A socurity ofthis oan and to ensure promot payment of the monthly amortization on due date | hereby revocablysislgn to AFPMBAI my wages, salaries, ‘tlowances and slies emoluments from all sourese, and appoint my Tressurer/Ousburing/Caleeton/AFF/PNP Finance Ofticer/centers/unts and/or Commanding (Othier/Head of Office or uni or Pension DibursingOfice, at my Attorney n-Fart to deduct therefrom such amount required under thi note for any reason, the Treasurer/Dsbursing/Colleclor/AFP/PNP Finance Officer/Centers/units and/or Commanding Offier/Mead of Officer unkt or Pension Disbursing Office fais to deduct from my wages/sslory/pension/ allowances and alied emoluments rom all utes, the fll monty amortization as falls due, shel Immediately remit directly to AFPMGAI the said amount/s of under remitance on or before the Sth day of the folowing month, Otherwise, any unpaid amortiation ‘due shal bear an edltlonal interest per month of delay unt fully paid In ease of default or fare to pay a ear three (3) consecutive monthWy smortiztions on the Indebtedness or the interest when due, then the entire pine plus the interest that hat ro far accrued shal, tthe option of AFPMIBAI immediatly Become due and payable without need of notice or demand and | agree f0 ay {fees charges and surcharges untl fully pal. In which case, | nereby authorize and empower AFPMBAI even without prior notice to me to colet/oteet any money of “whatever kind oF neture securities and things of value hich may bein ts hands oF otherwise tothe credit of or belonging to me. AFPMBAL is hereby authorized to {Eilat public or private sle such securities or things of value forthe purpose of apelving ther proceeds ax payment of thi lon new loan account and any unpala balance from the ald loan shal form part ofthe new loan amount subject for calleton, further agree that in case of separation from the service for whatever cause, the unpaid balance, including its accumulated interest and surchenges a stipulated shove, shall be deducted from my lare payment commutation of lesves, furlough, AFP RSOS refund, pension and all other separation benefits and thereby wale My Fights under opplicable rules In case of pre-termination of my foan, the computation of my outstonding loan Balance shall be In eecordance With the existing ‘actual and consequential damages, 10% hgudated damages, and 20% atomey’s fees, 35 wel as oer necessary and incidental expenses. | hereby understand and acknowledge that | have read the printed provisions and written entries of this Promissory Note and fily gree tothe terms and ‘conditions prior tothe consurnmatin ofthe credit transaction and confirm the same. Iam executing this Promissory Note with ful knowledge of my obligation and ‘Out of my own fee wal ond voluntary aet ond deed POLICY NO.. | hereby authorize the you to deduct from my salry/ctirement benefis/eommutation of leave ctedts/pension and pay the amount of e J every month for months beginning for the payment of my lean amortizaions unt fll settlement ‘hereof with tha ARMED FORCES AND FOUCE MUTUAL BENCHIT ASSOCIATION, INC. (AFPMOAIL | further authorize my personal information under my Une/Otice te outstanding remaining balance including interest, penalties, and otner charges to AFPMIA from any anal pay and Benet due me er my legal ner fe my Untimely death. hereby expresly waive all my rights under Section 13 Rule 39 ofthe Rules of Court Republic et Nos. 138 (Pay Status of AFP, 6875 (PNP Law), 2310 [agp Retirement Benefits), 4917 (Retiement Bonetts of Employees of Private Fis), 9530 {Credit Information System), 10473 (Data Privacy, and to any and “ly understand thatthe loan obligation a contract between the AFPMBAI andthe undersigned borrower and ths, hereby assume oll the obligations thet my rise theceot and hereby understand that the Finance Sesce i ot priy tothe contract of lan execited withthe AFPMBAI buts merely authorized pusuant 0.GAA tO ‘deduct loan obigaton/s from te salaries of PMP employees Tank ‘orowers Family Name/Firt Name/Mile Neme SN Branch TH Slanoture above printed name ofve ‘ne Asrlanment ‘aatne/ Mobile Nox Email address Acknowledgment Republic of the Piippines) ss. proof of identity kncwn to me to be the sare person wha executed ths Authorization to Deduct (ATD) and acknowledged to re that the some is hs free and WITNESS MY HAND AND NOTARIAL SEAL oc No. Notary Public Book No:TO: CO, FINANCE CENTER hereby authorize Armed Forces and Police Mutual Benefit Association, Inc. (AFPMBAI) to automatically deposit my Dividends, Bonuses, Maturities and/or Refunds to the bank account details | have with them or through other accredited payment facilites (eg. Palawan Express Pera Padala) forall of my existing policy (ies) and/or loans with AFPMEAL, (© Bank © Acct Name (© Bank Branch, (© Acct No. THUMAMARKS Rank — Member's Family Name/First Name/Midale Name SN “Branch of Service Signature above printed name Unit Assignment Celiphone Number Email Address TO: CO, FINANCE CENTER hereby authorize Armed Forces and Police Mutual Benefit Association, Inc. (AFPMBAl) to automatically deposit my Dividends, Bonuses, Maturities and/or Refunds to the bank account details | have with them or through other accredited payment facilites (e8| Palawan Express Pera Padala) forall of my existing policy (ies) and/or loans with AFPMBAL, © Bank © Acct Name (© Bank Branch © Acct No, THUMBMARKS Rank — Member's Family Name/First Name/Midale Name SN “Branch of Service Signature above printed name Unit Assignment Celiphone Number Email Address