COMMISSION ON AUDIT

Quezon City
GSIS LOAN APPLICATION APPROVAL SLIP
(Pre-requisite to GSIS Loan Application)
Name: _________________________________ Office :_______________________________
Contact No. ______________________________ E-mail Address: ___________________________
Type of Loan:__________________________________ NEW RENEWAL

CERTIFICATION
This is to certify that the abovenamed Member-Borrower:
1. Is a bonafide employee of the Commission.

___________________________________________
Signature over printed name of Immediate Supervisor
2. Is not on leave of absence without pay as of the latest available leave records.

Certification of Leave Date and Time Received:

__________________________ Credits (VL & SL)
Signature over printed name of ___________________________
Leave-in-charge, Leave and Retirement Services Vacation Leave:
Human Resource Management Office ____________________ Date and Time Released:
Sick Leave: ___________________________
____________________
As of:
____________________
3. Has no pending administrative case in this Commission as per available records of the Internal Affairs Office (IAFO)
as of the date of signing. That IAFO can only certify as to the existence of administrative case/complaint instituted
by, or filed/lodged before this Commission.

_______________________ Date and Time Received: ______________

Signature over printed name Date and Time Released: _______________
of Authorized Internal Affairs Office, COA personnel

4. Has a net take home pay of Ph _____________ as of _________________ and has a monthly loan deduction of
______________, for the same type of loan applied for (if renewal). The Finne Office shall prioritize the payment of
GSIS loans over and above the payment of loans taken by personnel from lending institutions.

_____________________
Signature over printed name Date and Time Received: ________________
of Authorized Accounting Office personnel Date and Time Released: ________________

5.
With Loan application In good standing Not in good standing with the Personnel Welfare
Administration (PWA).

_______________________
Signature over printed name Date and Time Received: ________________
of Authorized PWA personnel Date and Time Released: ________________

“I hereby confirm that I have no pending administrative and/or criminal case in any court or quasi-judicial body
within and outside the Philippines; That the payslip submitted at the time of application reflected all deductions from existing
approved loans; That I undertake to deduct any or all benefits due to me including terminal leave benefits in case of resignation,
separation, retirement, death or permanent total disability as payment of my outstanding GSIS obligation; That I shall submit
GSIS Clearance, to the LARS, HRMO, upon separation and prior to the release of my terminal leave benefits pursuant to
Section 39, RA 8291; That I will solely be held liable in case of arrearages/default/non-payment of the said loan; and That all
the information provided herein are true and correct as of date of application.”

__________________________________________________
Signature over printed name of Member-Borrower

SUBSCRIBED AND SWORN to before me this ________________________ in Quezon City, Philippines. Affiant
presented to me his/her COA Identification Card as competent evidence of his/her identity.

Doc No._____________; NOTARY PUBLIC

Page No. ____________;
Book No. ____________;
Series of _____________
.