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(I) RepubliC of the Philippines

D&PAIl"tIDWl' 0., BDUCA'I'IOB
PllOVIDD'I' J'UJID LOAir
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Date 5u~Itted~
Loan AnlOImt:

Type 01 Loan:
I
IPltP

Term:t
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yeartsl
Loan AppIfeation No.
Purpose:
o Educatfonal
. C HospItalization/Medical
1--· I

[J MultI-purpose [] Lone MedIcatIon/Rehablltlltion

Cl New C
o Renewal
[J Additional
. D
o
House Arrears/Equity
House Repair - Major
House Repair - Minor
. C Payment of Loans from Priv.iIte Institution
Cl catamity
Q C Others (spedfyt:

Borrower"s Information Co-Maker".1nfonMtIGn

~
(SUlrHlme) (FImNomeJ (MI.} (Sumanrel (Rtst Nllmel {MoL}
Home Address: Home Address:

Position: t Position:
Employee No.: Employment Statu.: Employee No.:
OffIce: --- Employment Status:

••
OffIce:
Date of Birth: Ace: Date of 8fr1h:
Monthly Salary: PhP OffIce tel. I:
.,. Salary:
Monthly PiiP Offtce tell:
Years In SeNlee:
DepEd E-mait IIddress: " MobllenG':" Vears in 5eNlce:
"dePf!d.gcw.ph - Mobile no.

Spa:tmen Stsnatures: Spedmen~

-
. LOAN AGREEMENT
1 hereby apply fM a PrcMdent Fur,d loan In the amount of PESOS:
(P 1. In
consideration of the crant 1hereof, I promise to pay all Installments due
based on the attached amortization schedule and bind ~ with die
terms and conditions of the loan as stIpuleted In the applicable
guldelJnes of the [)QpEd Pnwfden.t Fund. Tttls document also serws as
the Promissory Nate upon approval ofttUs loan.
AuordlntlY. I hereby authorize the deducUons of the monthly
arnortiution #Tommy sallMy. Should I be sepal1ltecl from the servtce. I
also hereby agref! to setdl! my outstandinl loan balance before the
date of my retiremenr/separatlon from the serY\ce, either throuah fuI
I hereby aaree to assume all the outstandI.,. obIlptlcrls for the IJ"8nt of
ltIl5 loan should the principal bonower be sepamed from the service.
and eittIer retirement or separation beneftts due to hlmJher is not
received or Is insufficient to U4Ue die borTowren outstiIndln& loan, and
upon proper notIfkatlon by the Provident Fund SecnarIat.
Q
Accordln&fy,I hereby authortza the monthly deduction from my salary
of die amortizations for the outstandIna obllptlDn of the principal
borrower untl hlsjher loan Is fuIv paid.

,
payment In cash or throuch dle execution of it notartxed Promissory
Note.

~ot8_tNefI'rllrkdName
., JIUQ ~of~I'rintedName - Dote -
CERl'IFICATE'''OF EMPlOYMENT AND CREDl8IUTY
Personnel Sec:tIon: •.•••• SectIon:
This Is to C«t1lY that the ~ I.oan appllcant/borrower: this Is to e«tify that the aboYe loan 'appllcant)borrower has no pending
(1) lsa _ permanent/_ CO-'cermlnus employee of this Office administrative nor eMl case cha'lfl aplnst hlm/hef besec! on records
and ISnot on leave of abstlnte without pay; M. ftIe wIIh DepEd.
(2) has net pay of PhP for the PIvroI month II
year of -iand
(3) has ,Iwtn the true ana correct Information on the lDan
AppMcatlonForm. •
.
SigIJllhn 0Nr Pttntftl Nate SigIIcIIuN t1WI Prfnt#!d NtIIM
g
Destgnatlon: Ileslgtttltlon:
DG~: Date:
 ---------

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Documents Submitted: [Two (2\ CopIes of.ach)
SECRETAR~T'SASSESSMENTJEVAWAlION.
_--~:~' --~ I
o Loan Application Form (LAFI P a Additional documents for Additional Loan~
~ o Authorization to Deduct 0 Letter request
0 Latest copy of pay slip a Hospltallzation/Medlcal Expenses
[J Photocopy of OepEd 10 o Medlall Abm'act/Certlflcate/PreSCriptlon/lXa&nosts
0 Approved Appointment (for FIRST TIME borrowers and C Baranpy/LGU c:erttftcate/resolutlon declaring
Co-terminus employees only) the borrower's place under StHe of Ulamlty
0 Copy of Notarized Contract of Servlce as proof of two (2)
years continuous service (for CD-t;rminus only)
0 Others (specify):

8. Completenes5 ..,d Veracity of SUbmitted Docul'fJents:

a Signed and completely filled out LAF
[J Complete supporting documents fOt"type 01 loan applied for
1:1 Slanatures on LAFare by authorized sianatorles
r-_d~ I~ I
--------- .._---_ .._---------------_ .._------------- - --
C. Elfllbility of the 8cmoww and Co-Maker
0 Borrower will nat reach the mandatory age retirement on or before the maturity of hl5/her loan.
0 Co-Maker will not reach the mandatory age: r.etirement on or before the maturity of the borrowet"'sloan.
0 Borrower has Outstanding PF Loan BalanC(~:
[5; I
o Current loan Balance IAmount: Ph" .

o Past-Due Loans IAmount: Ph,. ,

0 No. of Years/Months Past-Due: IY~/.s: IMcmthls: I
0 Borrower's Net Take--Home Pay a~ df!duction of monthly amortization of the loan bemc applied for Is ~qual to or
higher than the required threshold lior the current year.
0 For renewal of loans: Borrower has pa,1d at least 3O%-ofthe
principal of the existing loan,
Percentage of prlndpa\ paid: I ~I r-'~ ~~
I
---_ .•. _ ..--------------------------
Computdon of loan:
,.
------ -----
D.
Principal Amount of Loan PhP Net Take Home Pay after Deduction PhP
Less: Outstanding Balance of Loan 'to be Renewed Monthlv Amortization PhP
Principal" PhP •• Period of loan (mm/w - mmlw)
Interest
Net Proceeds PhP Date Processed:

Rem.rk5:
Processed by:
Signature over Printed Name
Seaetartat, Rqional80ard OtTrustees \RBT}

Reviewed by:
Signilture over Printed Nilme
Secretariat. ROT
P

ACTION TAKEN:

Recommendtna Approval: 0 Apprcwecl

,. 0 Dlsapprawd

Head, Pf $eeretarlat, RBT Chairperson. Depfd PF RII'r

'bate: •• Date:
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AurHORlZATION FOR SALARY DEDUcnON

Administrative Division
DepED. Regional Office XII

I hereby authorize the cledu\:tion of PESOS (P ) from

my salary fOT__ months. ftotu' • 20 _ to .---J 20 ---J or until my total
outstanding loan of PESOS (P ) plus intm'est has been fully
paid. Amount deducted shalt be credited to the a«ount of Ihe DepEd PJ'OVi~t FWld as receivables an the saiclloans.

SisJtabm: of Borrower over Printed Name

Employee No.: OfticelDivision:

Designation: ------------------~-- ServiceJBureau: ---------------------------
Status: ~:------------------------

,
AUTHORIZATION FOR SALARY DEDUcnON

dministratlve Division
DepED. Regional Office XII

I bereby lutborize the deductionOf .~ PESOS (P ) from

my salary for __ months. from • 20 to , 20 ----J or UDtilmy total
outstaDding.loan of PESOS (P ) ptas interest bas been fully
paid. Amount deducted shall be credited to the account of the Depl:d Provident Fuad as receivables on the said loans.

Signature of Borrower owi Primed Name

Employee No.: OfIicM>ivision:

Designation: --------------------- SCfVicelBun:au:-----------------
S~:--------------------- Code:
~=------------------------
--. -----_._---- --~----
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• "fAIt-- at Ou~ia •
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PIlOVIDIIIIT IVIID LOAII •••••••••••• I7_

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Name of AppIic:aDt: -...

Loan Am01Ult: ...:...., , '•_
.._ _
Type of lAaD~ New, Renewal. Additional
A. ••• .,..
. a.o.n AppHoadnn Porm (LAP')
.....)Cq.• .,•• ,
~ I.t.~~ ~~ Alithoriadton to Deduct
"fbi \~ k .l.IltMt oopy or pay ebp IOrd£I d -.,t
, ~ PbotaaDpy of o.pBd tD
Approved AppoiDtIDent (for FIRST 77MB bGrnJuMr8 Gftd
Cof8mdrwa ....",. ••• oitIf/J
Cop) or Notarised Contract of Somca •• pNOf of two (2)
y.ara continuo":'._ •• n_ (Jbr ~ GlllMJ

•
Othe •••(ap~):
.••••••••••••••••• 1_ A"·....., £Dan:
IAttar requ •• t
HoaOitaliMtiOft/Medicai Ib:pen_.
Medtcal Abrltnpt/Certifiade/Preaeription/Diepoaia
Baran..,/LGU certifieate/naoJution d•••.••••
the boarower. plt1C8 un'" Stae or c.Iaroby

•...,..:~ ••••.••••• ~ ••• \W t•• "~."w...~

•••• ~ •• ,'t,.: .•••.•••••.••..
' •••••••• ,,1tW '_." •••. ,.. •••
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Ul'Pltbht 01 nit pl)lhpiJlJtts

Drpi1rtm~nt of Clfbu(111ion
~OCCSKSAR.GfN RF.('ION

DEPED pao\fJDEIT FUND WAR

AMORTIZATION SCHEDULE
.,. Diminishing Intere"4t per DO 52, s. 2011

lO~N MONTHLY AMORTIZATION

AMOUNT UMos 24Mos 36 Mos' 48Mo$ /SOMos
10,000.00 860.67 443.21 304.22 234.86 193.33
20,000.00 1,721.33 886.42 608.44 469.71 386.66
30,000.00 2,582.00 1,329.62 912.66 704.56 579.99
40,000.00 3,442.66 l,n2.83- 1,216.88 939.41 773.32
50,000.00 4,303.33 2,216.04 1,521.10; 1,174.26 996.65 .
60,000.00 5,163.99 2,659.24 1,825.32 1,409.11 1,159.97
70,000.00 6,024.66 ),102.45 2(.129.54 1,643.96 1,35330
80,000.00 6,885.32 3,545.65 2,433.76 1,878.81 1,546.63
90,000.00 7,745.98 3,988.86 2,737.98 2,113.66 1,739.96
100,000.00 8,606.65 .,432.07 3,()42.20 2,348.51 1,933.29 ~
I 120,000.00 10,327.98 5,318.48 3,650.64 2,818.21 2,319.94
130,000.00 .11,188.64 5,761.68 3,954.86 3,053.06 2,513.27
.,,I 140,000.09 12,049.31 6,204.89 4,259.08 3,287.91 2,706.60
'I 4,563.30 .
fl 150,000.00 12,909.97 6,648.10 3,522.76 . 2,899.93
,I .200,000.00 17,213.29 8,864.13 6,()84.39 4,697.01 3,866.57
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