‘ARMED FORCES AND POLICE MUTUAL BENEFIT ASSOCIATION, INC. (Cal Bony Sarrans Reed corE. Delos Santos Avarue, Camp Aguinala, Quezon Cay Contact Nos, (02)8€22-MBAI (6224) Website: wrw-fpmibaicom.ph a mai: mal@aforba.ph Facebook @AFPMBAIDACial Tan remo ae axa Tom Wee oleae of Claim /Bonolt /Rofnd Croucy — Dexranoeo DrorPickup lead offco (OMA Branch Ocatlphone Draury = Qsauany Drorbeposit___ OATM/AcetNe eaary Oven (Please put a check markin the box, if you agree) Any future unclaimed Refunds or any other claim Dewenceney Comers Pertiment to oan shall automatically be deposited in the ATM account ofthe claimant snare oan Purpose Orersonet Causiness others “anowntinFigaes | tom fom Payment Made weavers) | pay DD oircearmant .. rose oats checks LAST NAME: MIDDLE NAME: FIRST NAME: [EXTN NAME: UR, SR} TNs DATE OF BIRTH (DD/MMIYY): AGE: RANK: SERIAL/BADGE/ACCT NO: RETIREMENT DATE: Bos: [UNIT ASSIGNVENT [GRIT ADDRESS: [CELL PHONE NO, [PHILSYS NO.(PSND EWAATL ADDRESS: [PRESENT ADDRESS: PERMANENT ADDRESS. Pursuant to Republic Act No. 9510 creating the Credit Information Corporation (CIC), its Implementing Rules and Regulations (IRR), and various Grcilars, the AFPMBANI i mandatad to submit the borrower's basic cradit data ar defined by la, 3= well 3¢ any regular updates or corrections thereof, te the CIC for consolidation and disclosure a= 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, for the purpose of establishing the borrower's creditworthiness, For more information, please visit the webste ar www creditinfo.2ounh ‘Ace you a Cose Family Member (legitimate or commomlaw: spouse, parent, child, brother, sister granéparent, grandchild, parentin-law, son/daughcer-in-iaw, brother sister‘ilaw, grandparentin-law, and grardchil-n-av) of ary of the AFPMBAI Board of Trustees, corporate officers (Chairman, vice Charman, President and CEO, Corporate Secretary Treasurer, Senior Vice-Presidents) and key management personnel (Heads of Sales and Operations Group, Corporate Services Group, Executive Services, Finance, Internal Audit, Area and Branch Operations, Legal, Information Technology, Admin, Real Estate, Human Resource, Insurance Sales, and Marketing)? no Direscrves inaicate therameotyourreatedpary) |AFPMBAI upholds an individual's data privacy rights and observes that all personal information, sensitive personal information and pri infonraton elected andtobecollecodareproctsed recorded managed, gone, fore, lated, teed conaifted wed eeu snd erased according to the Data Privacy A@t of 2012 (RA 10173}, itsimplementing Rules and Regulations (IRR), and various Circulars under the principles of transparency legitimate purpose, and proportional | hereby give my consent te the processing, sharing, and/or transferring of my personal data relating to my accounts, without notice, to AFPMBAL, its service providers and entities or third parties having authority or right to such disclosure of information as in the cace of regulatory agencies, ‘governmental or otherwise, which have required such disclosure from AFPMBAI, also to enable AFPMBAI to service my account/s, to provide al exsting features and future enhancements thereto, and to avail other AFPMBAI products, services, facies and channels as the AFPMBA\ deems necessary agree to hold AFPMBAY, its affiliates, subsidiaries and third party service providers free and harmiess from any lablity arising from or in connection with ‘the consent herein gwen. AUTHORIZED REPRESENTATIVE ‘BORROWER'S SIGNATURE, SIGNATURE OVER PRINTED NAME Lump .ABOD ‘ActedasCo-materto: Loan Evaluation Policy /Basic Cert. Nr Optional Insurance SPL Kowal Kalinga) Salary Loan Face Amount ‘Optional Potcy Loan Appliance Loan MEDAL "art Loan Premium Basic Policy Loan Calamity Loan cata Lea, fective Date ‘Momber's Equty Lear, MEDAL Appliance Loan ee Ase wy ———— Neember's status oan Term Plan 56 REHL/REML tembe Noted by E56 Policy Loan ried by Date Salary loan Noted by [2] | 30 | 36 [Rate per P1,000.00 333 | ai7 [500 [735 [i0as [i298 [35.75 3. Health Declaration to support SLAI/CRI is required for loans above P200,000.00 and shall be incontestable after being enforced for 1 vyear from the date of effectivity. 4.1f loanis fully paid or renewed prior to its msturity, SLRY/CRI rebste is made except for loans with remaining term of less than one year. 5.ln case of borrower's death, if joan 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 inicluded). Any unpaid balances should be deducted from his/her Death Benefits; c) is dormant/expiced term - loan covered by SLRI/CRI. Direct 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/iabilities. SERVICE RECORD CLEARANCE THIS 15 TO CERTIFY that subject personnel is a bonafide BIMP | THIS IS TO CERTIFY that subject personnel has NO PENDING CASE. personnel on a permanent status. Director, Directorate for Pareonnel and Record: Management Chief, Legal Service Office FINANCE THIS IS TO CERTIFY that subject personnel has a NET Take Home Pay of P. and P. available for loan payment, Chief, Finance Service office sof tare 7020For value received, | promise 10 Day t9 the Order ofthe Armed forces and Police Mutual Benefit Adsociation, Ine (AFPMBA, the principal amount ard interes Including the penalties, charges and others costs ifany. as follows: PRINCIPALLOAN AMOUNT oan ream, move or ravment: — E]payrott veauetion INTEREST RATE : [MONTHLY AMORTIZATION Boirect payment TorAt oBuGATON rose vated cnects AAccertence by AFPWOAI eI etre of any aroun after wy obligation hes become se in secordance herewith shall et be eonelered ay extending the tine or ‘As socurty of ths loan ane to ensure promp! payment of the monthly amortization on due dete, | hereby erevocably assign to AFPMBAI my wages, sabres, allowances and alee emoluments fom all sources, and appoint my Treasurer/Disbursing/Colecton/AFP/PNP Finance Oficer/Certers/uns and/or Commanding, Otficer/teadof Office or unit or Pension Dabursing Office, az my Aitorney-in-Fact to deduct therefrom such amount required under tis note. WF for any reaion, the Tresewrer/Deburang/Collacion/AED/ONP Finance Cffcer/Centar/unite and/or Commanding Ofier/esd of OMe or unit or Pension Disbursing Otis file to deduct from my wages/sslary/persion/ allowances and lied emoluments fem all sources the lullmanthly amortization arta due, tahal Immediately remit diccty to AKPMBAI the sid amounts of under remittance on or batare the Eth day ofthe fllowing marth, Otherwise, sy unpaid amortiation ‘ion chal baw an atonal ntaent per ment of dalay wr aly pol In case of default of flere to poy a least three (3) consecutive menthiy amertzations nthe indebtedness ofthe interest when due, then the entte principal plus the interest that has 50 lar accrued shal tthe option cf AFPMUAI immediately Became die and payable without need of notice oF demand and agree to ay ny cutitanding amount due on this loan plus interests thereon atthe rate of interet stated above onthe said armount due compounded monthly together witha fees, charges and surcharges unt uly pala. In whieh case | hereby authorize ang empower AFPMBAI even without prior nace tome to collecVottset any roney OF {et at pubic or private sale such securities or things of value forthe purpose ot apptyng thelr proceeds as payment oft loan {agree that in eae of loan renewal, payments fer my loin that have not been considered or coleted in my oan renewal shall be automaticaly credited 10 my new loan account ané any unpaid balance from the a loan shal form part ofthe new loan arsount subject for clletion Fight under applicable rules In cave of pre-termination of my toon, the computatien of my outstanding toon balance shal be st seordance with the ensting {uidelines, orders and policies berg implemented bythe Assecietion In ease of non-payment and tn notes refered for collection, | agree Wo pay aasluon te and based on the oUsLnding amour due and Ne Cost OF he Sul, 30% actual and consequertil damages, 10% iquldated damages, ane 20% attorneys fees, as wales oer Necessary ane Iclental Oenses {hereby understand and acknowledge that | have read the printed provisions and wten entries of this Promissory Nete ard fuly agice te the terms and condtiens prior to the corsumnmation of the credit transaction and confirm the same. Lam executing this Promissory Note with fll knowledge of my obligation and ‘Ut of my own free wil tnd voluntary act anddeed. Benen ty. Phones 20. 1 hereby auinorise the you to deduct from my silay/reirement enefes/commutaton of leave credis/persion and pay the amount of ° every mom for mont begin {fer the payment of my Koon aoa eth fal setserne ‘reveal with the APMED FOREEE AND POUEE MUTUAL BENEFIT ASSOCIATION, INC (AFPMOAI, | Further authorize my personel information under my Uni/OMee the outstanding remaining belance netuding terest, penoien, and ether charges to AFPRIGA! from ony end oll pey and benef due re OF my Tegel ets for my ‘numely death, |ereby exoresay waive ello rights under Section 19 Rele 39 ofthe ules of Coure Repubte Ae Nos. 130 Pay Stotus of AFP), C975 (PNP Lo), 2336 {AeP Retrement Donate), 4917 (Retemert denetts of Employees of Private Firms}, 9640 (Cret Information Sytem), 30273 (Cota Frvaey, and to ny and al "uly understand thet wie loan obtgaton a contract between the AFPMBAL and the undersigned borrower an thus, Pereby assume al the obi sree theref and hereby undertend that he Fnance Serviceta nt privy tothe contract of oan exceed wth the AFPMBAI But meray aut ‘Seduct loan otigationys om wesaares of PNF emplorees Rant oer Faly Noma/fr Nara /iaala Name wane 7 Signetue eboveprmted name ose ‘Unit Acslenment ‘adine/ obi Nos ‘roll Address Acknowledgment epubic of the Philopines) 2 ‘Setore me, » Notary Public for ne rervonsby sppsered the sboventmned sppleest and showed compatent root of identity known to-me to be the eve parton who executed the Authovition te Deduct (ATO) and astnoutedged to me that the same ie hie few sd WITNESS MY HAND AND NOTARIAL SEAL oc Ne. Notary Public Poe No sof tare 7020‘TO: CO, FINANCE CENTER Si I 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 I have with them or through other accredited payment facilities (eg Palawan Express Pera Padala) for all of my existing policy (ies) and/or loans with AFPMBA\. (© Bank (© Acct Name (© Bank Branch © Acct No. THUMBMARKS Rank — Member's Family Neme/First Name/Middle Name SN “Branch of Service ‘Signature above printed name Unit Assignment Ccliphone Number Email Address ‘TO: CO, FINANCE CENTER Sirs | hereby authorice Armed Forces and Police Mutual Benefit Assocation, 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 facilities (eg. Palawan Express Pera Padala) for all of my existing policy (ies) and/or loans with AFPMBAI. (© Bank (© Acct Name (© Bank Branch © Acct No. THUMBMARKS Rank — Member's Family Name/First Name/Middle Name GN “Branch ol Service Signature above printed name ‘Unit Assignment ‘Cellphone Number Ema Address Bs oftare 7030