REPUBLIC OF THE PHILIPPINES

SOCIAL SECURITY SYSTEM

PENSION LOAN APPLICATION AND

DISCLOSURE STATEMENT (ONLINE)
(As Required under R.A 3765 Truth in Lending Act)

SS Number : 03-7260011-2 Date of Application : October 27, 2023

Name of Borrower : ALMERO, BLANDINO CARCILLAR Name of Disbursement : PHILIPPINE NATIONAL
Account BANK
Date of Birth : June 06, 1960 Disbursement Account : 243110135844
Number
Address : B30 L9 ACM PARAMOUNT HOME NAVA Mobile/Cellphone Number : 09064042490
RRO GEN TRIAS CAVITE Email Address : blandinoalmero@gmail.com

PENSION LOAN DETAILS

1. LOAN AMOUNT P 90,684.00 3. EFFECTIVE INTEREST RATE 10.47%

Less: CLI Premium 2,767.68 4. NET TAKE HOME PENSION P 5,891.52
Service Fee 1.05
Bayanihan Refund 0.00
NET PROCEEDS OF LOAN P 87,915.27

2. SCHEDULE OF PAYMENTS

Applicable Month Amount Outstanding Principal

Amortization Interest Principal Balance

P 90,684.00
December 2023 4,184.61 755.70 3,428.91 87,255.09
January 2024 4,184.61 727.13 3,457.48 83,797.61
February 2024 4,184.61 698.31 3,486.30 80,311.31
March 2024 4,184.61 669.26 3,515.35 76,795.96
April 2024 4,184.61 639.97 3,544.64 73,251.32
May 2024 4,184.61 610.43 3,574.18 69,677.14
June 2024 4,184.61 580.64 3,603.97 66,073.17
July 2024 4,184.61 550.61 3,634.00 62,439.17
August 2024 4,184.61 520.33 3,664.28 58,774.89
September 2024 4,184.61 489.79 3,694.82 55,080.07
October 2024 4,184.61 459.00 3,725.61 51,354.46
November 2024 4,184.61 427.95 3,756.66 47,597.80
December 2024 4,184.61 396.65 3,787.96 43,809.84
January 2025 4,184.61 365.08 3,819.53 39,990.31
February 2025 4,184.61 333.25 3,851.36 36,138.95
March 2025 4,184.61 301.16 3,883.45 32,255.50
April 2025 4,184.61 268.80 3,915.81 28,339.69
May 2025 4,184.61 236.16 3,948.45 24,391.24
June 2025 4,184.61 203.26 3,981.35 20,409.89
July 2025 4,184.61 170.08 4,014.53 16,395.36
August 2025 4,184.61 136.63 4,047.98 12,347.38
September 2025 4,184.61 102.89 4,081.72 8,265.66
October 2025 4,184.61 68.88 4,115.73 4,149.93
November 2025 4,184.61 34.68 4,149.93 0.00
Total P 100,430.64 P 9,746.64 P 90,684.00

CERTIFICATION AND AUTHORIZATION

I certify that all the information provided in this form are true and correct and I hereby acknowledge the amount indicated herein as my
indebtedness to SSS.
Further, I authorize SSS to do the following:
1. Automatically deduct from my regular monthly pension the required monthly amortization following the above schedule;
2. Apply for a credit life insurance in relation to my pension loan, for and in my behalf, and deduct the premium thereof from the proceeds of my
pension loan;
3. Pay any excess in the insurance proceeds after payment of the outstanding balance of the loan to my rightful beneficiary. In any case that
should there be no identified or nominated survivor/beneficiary, excess insurance shall be forfeited for the benefit of SSS or
shall be for the account of SSS. Implementation of which, shall be two (2) years from the date of insurance claim; and
4. Deduct the corresponding Service Fees from the proceeds of my pension loan.
 REPUBLIC OF THE PHILIPPINES

SOCIAL SECURITY SYSTEM

PENSION LOAN APPLICATION AND

DISCLOSURE STATEMENT (ONLINE)
(As Required under R.A 3765 Truth in Lending Act)

Also, I agree that this pension loan shall, at all times, be subject to the attached TERMS AND CONDITIONS of the Pension Loan Program.

DATA PRIVACY CONSENT

In compliance with the Data Privacy Act of 2012 (Republic Act No. 10173),Social Security Act of 2018 (Republic Act No. 11199), and the Credit
Information System Act (Republic Act No. 9510) and their corresponding Implementing Rules and Regulations, I hereby agree and authorize the
following:

1. For SSS to use my personal and loan information to process my application for pension loan including verification from the source of
such information and for the establishment, exercise or defense of SSS’ legal claim;
2. For SSS to share my personal and loan information to the insurance provider, bank and its affiliates for the following purposes:
· Process my application for insurance coverage in relation to my pension loan;
· Disbursement of my pension loan to my bank;
· Process any claim for benefits from my insurance policy for and in my behalf; and
· such other related request
3. For the insurance provider to share my personal and loan information to third-party insurance provider/s for reinsurance purposes;
4. For SSS to share my personal and loan information by contract with partner companies like banks, collection agents, or IT contractors
to provide me with efficient and efficient service; and
5. For SSS to share my personal and loan information based on available SSS records with the Credit Information Corporation as the central
repository of
credit information.

I also acknowledge and warrant that I have acquired the consent from all parties relevant to this consent and hold free and harmless and
indemnify SSS from any complaint, suit, or damages which any party may file or claim in relation to my consent.

WARNING
ANY PERSON WHO MAKES FALSE STATEMENT IN THIS APPLICATION OR SUBMITS ANY FALSIFIED DOCUMENT IN CONNECTION
WITH THE APPLICATION FOR PENSION LOAN SHALL BE LIABLE CRIMINALLY UNDER SECTION 28 OF R.A. 11199, AND/OR UNDER
PERTINENT PROVISION OF THE REVISED PENAL CODE.

This is a system-generated Disclosure Statement and does not require a signature from SSS.