LIPI EMPLOYEES MULTIPURPOSE COOPERATIVE (LIPIEMCO)

c/o Unit 3 2nd Floor Maroo Realty Bldg. Mantawi Int'l Drive, Subangdaku Mandaue City
Tel. 6332-5209367

LOAN APPLICATION FORM 004

EXPRESS LOAN
LOAN DETAILS:
Amount Applied: (max of P20,000) 20,000.00
Purpose:
education x house repair/ vehicle house hospital bills
improvement maintenance utilities
life insurance
others, pls specify:
Term Applied: (max of 5 months)
1 month 4 months Credit Rate:
2 months x 5 months MIGS Rate:
3 months

OTHER TERMS AND CONDITIONS:

interest rate _________ outstanding loan balances + interest
service fee __________
Collaterals/Securities required:
REM Chattel Mortgage ATM/PDC
Deed of Assignment others, please specify: ________________

MEMBER'S/APPLICANT'S DETAILS:
Name Jesse M. Carredo Member # 1126416
Present/City Address Consuelo Village, Basak Mandaue City Company Lexmark
Department CI
Employment Status Regular
Yrs of employment 11

rented owned TIN 250 923 872

x living with parents/relatives
Active Bank/ Account #
Provincial Address
Contact # 09173153051 Email Add. jcarredo@gmail.com

Spouse name Flordiliza Carredo Contact # 032-2380744

Employer N/A
Employer Address N/A

Other sources of income:

borrower spouse total
salary
business
others
total

PERSONAL DATA AUTHORIZATION:

I hereby authorize LIPIEMCO to share my personal data / information in compliance to rules & regulations of LIPIEMCO
and to Philippines LAWS. This includes storage in any medium processing of such data for administrative & record keeping
purposes.

Jesse Carredo
Member-Applicant's Name & Signature

CREDIT COMMITTEE ACTION:

APPROVED approved amount:
DISAPPROVED approved term:
DEFERRED
reasons for deferment:

SGD:

Revised | February 2014

 LIPI EMPLOYEES MULTIPURPOSE COOPERATIVE (LIPIEMCO)
C/o Unit 3 2nd Floor Maroo Realty Bldg. Mantawi Int'l Drive, Subangdaku Mandaue City
Tel. 6332-5209367

Promissory Note Date : _____________

Maturity Date : _____________

PROMISSORY NOTE

For value received, I promise to pay to the LIPI EMPLOYEES MULTIPURPOSE COOP
(LIPIEMCO) or order, the sum of PESOS: _______________________________________________
(P____________) plus interest at the rate of 1% per month, payable in installments of
________________________________________________________________________________
(P____________) the first payment to be made on ________________ and a like amount every
installment period until the full amount is fully paid.

To further secure this loan, I hereby pledge and assign to LIPIEMCO my salary & wage,
savings/time/fixed deposits, investments and patronage refunds and interests thereon. In case of
my separation or resignation from ____________________________________________________
employment before full payment of this loan, I likewise pledge and assign my retirement or
separation pay, pension, including but not limited to our advance pension, if any. For this purpose,
I hereby appoint and designate with the understanding not to revoke this
appointment/designation without written authority of LIPIEMCO, my employer or attorney-in-fact,
to pay the loan by deducting or collecting from any or all of the aforementioned income and
emoluments due to me in such amount as to satisfy the principal, interest and penalties, if any, for
said loan.

In case of any default in payments as herein agreed, the entire balance of this note shall
become immediately due and payable, at the option of the holder. Each party to this note whether
as maker, co-maker, endorser or guarantor; severally waive presentation of payment, demand
protest and notice of protest and dishonor of the same.

It is further agreed that in case payment shall not be made at maturity, I shall pay a penalty
of _____ per month plus cost collection, and attorney’s fees in addition to the principal and
interest due on this note. Such charge in no event to be less than ONE THOUSAND PESOS
(P1,000.00) and that said suit shall be subject to the jurisdiction of the courts of Cebu City., or
Mandaue City.

Jesse Carredo
____________________________________
Name and Signature of Maker

ID No. __________________

NOTE: To be filled out only when advised/required by LIPIEMCO:

Name & Signature of Co-maker Name & Signature of Co-Maker

ID No. ID No.
Contact No. Contact No.

Revised | February 2014

 LIPI EMPLOYEES MULTIPURPOSE COOPERATIVE (LIPIEMCO)
c/o Unit 3 2nd Floor Maroo Realty Bldg. Mantawi Int'l Drive, Subangdaku Mandaue City
Tel. 6332-5209367

PLEDGE OF DEPOSIT
Jesse Carredo
I, _____________________________________________________________, hereby pledge all deposits and
payments of shares I have or may hereafter have in LIPIEMCO as security of the aforementioned loan as
evidenced by this loan dated _____________________ in the total amount (principal & interest)
___________________________________________________________ (P_____________) executed by me
payable to LIPIEMCO.

I further agree that if I fail to pay any installment of the loan when due, unless excuses therefore for causes by
LIPIEMCO Board of Directors, I promise to pay amount due including interest, fines and other costs, expenses in
accordance with the terms of LIPIEMCO policies.

Jesse Carredo
___________________________________________
Maker's Printed Name & Signature
Date:

NOTE: (Co-Makers) To be filled out only when advised/required by LIPIEMCO:

______________________________________ ______________________________________
Co-Maker's Printed Name & Signature Co-Maker's Printed Name & Signature
Date: Date:

______________________________________ ______________________________________
Co-Maker's Printed Name & Signature Co-Maker's Printed Name & Signature
Date: Date:

AUTHORITY TO DEDUCT
Jesse Carredo 1126416
I, _____________________________________________, with ID no __________________ hereby authorize the
Lexmark
Finance Department of _______________________________________________ to deduct from my salary the
(Name of the Company)
amount due me of this loan in semi-monthly installments until its full payment and remit the same to LIPIEMCO
this coming pay period.
In case of my separation or resignation, I hereby authorize LIPIEMCO to get the proceeds of my resignation or
separation pay as payment of my obligations in LIPIEMCO.

Jesse Carredo
___________________________________________
Maker's Printed Name & Signature
Date:

Revised | February 2014