Kaagapay ng komunidad sa Maginhawang Pamumuhay

SOCIAL HOUSING FINANCE CORPORATION

North Luzon Branch
2nd floor Letjoelou Bldg., Don Jose Canciller Avenue
District 1, Cauayan City, Isabela

MB No.: _____________

CA Name: RISING SUNVILLE SUBDIVISION HOMEOWNERS ASSOCIATION, INC.

Address: Bugallon Proper, Ramon, Isabela 1x1
HLURB Reg. No. _______________
ID Picture

Contact No.: ____________________

Please write legibly and fill-out all the details below. Write N.A. if not applicable. Kindly attach Photocopy of valid I.D
(government issued ID), if married, attach photocopy of Marriage Certificate

Block No. Lot No. Area (sq.m)

GOVERNMENT ISSUED ID PRESENTED: ________________________________________________________

PERSONAL INFORMATION
SURNAME FIRST NAME MIDDLE NAME
__________________________ __________________________ _______________________

GENDER: MALE [ _ ] FEMALE [ _ ] DATE OF BIRTH: _________________________ AGE: _________

PLACE OF BIRTH: ___________________________________________________________________________
CIVIL STATUS: Single [_] Married [ _ ] if married, name of spouse: ____________________________
Widow [ _ ] Widower [ _ ] legally separated [ _ ]

RELIGION: _______________________________ NATIONALITY: ___________________________________

EDUCATIONAL ATTAINMENT: ________________________________________________________________

EMPLOYMENT INFORMATION

OCCUPATION: ____________________________ GROSS HOUSEHOLD MONTHLY INCOME: ____________

EMPLOYER: ______________________________ EMPLOYEE STATUS: _______________________________
YEARS OF TENURE: _______________________

SSS NO. ____________________ GSIS NO. ____________________ PHIC NO. ___________________________

TIN NO. ____________________ COMPANY ID NO. _____________________________

PAG-IBIG ID NO. ( IF PAG-IBIG MEMBER): _____________________________________________________

ACTIVE [ _ ] INACTIVE [ _ ] DEDUCTED TO SALARY [ _ ] VOLUNTARY [ _ ]
SPOUSE PRESENT EMPLOYER: ________________________________

FAMILY DATA

NAME OF SPOUSE: ____________________________ AGE: ______ NO. OF CHILDREN: _______

BIRTH DATE OF SPOUSE: ______________________ PLACE OF BIRTH: ______________________________
 FAMILY INCOME AND EXPENSES

Income
Member-Beneficiary Gross Monthly Income __________________
Spouse Gross Monthly Income __________________
Business Income __________________
Other Income __________________

Total Household Income P __________________

Less: Expenses
Food Expenses __________________
Clothing Expenses __________________
Appliances Loan __________________
Medicine Expenses __________________
Electric Bills __________________
Telephone Bills __________________
Monthly Rental __________________
Water Bills __________________
Tuition Fees (Education) __________________
Transportation Expenses __________________
Insurance Expenses __________________
Others __________________
Total Expenses P __________________
Net Income P __________________

On-Site [ _ ] Off-Site [ _ ]

PRESENT PLACE OF RESIDENCE: PRESENT PLACE OF RESIDENCE:

__________________________________________ __________________________________________
YEARS OF RESIDENCE: _________ YEARS OF RESIDENCE: _________

PAST RESIDENCE: PAST RESIDENCE:

__________________________________________ __________________________________________
YEARS OF RESIDENCE: _________ YEARS OF RESIDENCE: _________

Structure Owner [ _ ] Structure Owner [ _ ]

Renter [_] Renter [_] P__________(monthly rental)
Sharer [_] Sharer [_]
ISF [_]
Caretaker [_]
Demolition [_]
Relocation [_]
Danger area [_]

We hereby certify that the above information’s are true and correct.

____________________________________________
Member-Beneficiary
Signature over Printed Name

____________________________ ____________________________ ____________________________

Spouse CA President CMP-M Chairman
Signature over Printed Name Signature over Printed Name Signature over Printed Name
 CERTIFICATION AGAINST DOUBLE AVAILAMENT

I, _____________________________, of legal age, single/married to ___________________________,

Filipino citizen and a bonafide member-beneficiary of RISING SUNVILLE SUBDIVISION HOMEOWNERS

ASSOCIATION,INC., do hereby solemnly swear that I have never been a recipient of any CMP loan or other
government housing program, does not own or co-own a real property and is not a professional squatter as defined
in RA 7279.

IN WITNESS WHEREOF, I have hereunto affixed my hand, this ______th day of _______________,
20__ at _____________________________, Philippines.

______________________________
HOA Member

With marital conformity:

___________________________
Spouse

CERTIFICATION

I, ____________________________________, duly elected Secretary of RISING SUNVILLE SUBDIVISION

HOMEOWNERS ASSOCIATION, INC., do hereby certify the veracity and authenticity of the foregoing personal
information and sworn statement provided by the above named HOA member.

______________________________
HOA Secretary
Approved by:

______________________________
HOA President

______________________________
CMP-Mobilizer

MB No. __________

Block No. __________ Lot No. __________

 AUTHORIZATION

This is to authorize Mr./Ms. _________________________________, my ______________________

to attend the scheduled SHFC Background Investigation (B.I) and Disaster Risk Reduction Management (DRRM)
orientation on hazard in my stead on ________________ at RISING SUNVILLE SUBDIVISION HOMEOWNERS
ASSOCIATION, INC.

Issued this ____th day of ______________________ at _______________________________, Isabela.

_______________________________________
Member-Beneficiary
Signature over Printed Name

Attached:
Photocopy of ID of _________________________(Member-beneficiary)
Photocopy of ID of _________________________(Authorized Representative)

MB No. __________

Block No. __________ Lot No. __________