Livelihood Loan application Form for DEPED

8/9/2019 Livelihood Loan application Form for DEPED

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nnex

LAND BANK OF THE PHILIPPINES Revised 5/2014

LIVELIHOOD LOAN APPLICATION/AGREEMENT FORM FOR DEPEDease rea erms an on t ons at t e ac e ore ng up t s orm

TO BE FILLED UP BY APPLICANT/BORROWER

Type of Loan: New New with Take-out enewal enewal with Take-out

egional Code !i"ision Code #tation Code PN Number

esidence $ddress %ip Code Tel& No&

Pro"incial $ddress %ip Code Tel& No&

'irthdate $ge ender Ci"il #tatus !epartment*ffice#chool +ale ,emale #ingle +arried idower

Type Position .mployee No& /ears 0n #er"ice *ffice#chool $ddress:

ank 1 ,ile *fficer

#0# No& T0N 'asic Pay Net Pay L$N!'$N2 Payroll $ccount Num

LOAN TAKE-OUT AGREEMENT

0 hereby authori3e L$N!'$N2 to take-out my e4isting loan with the following Pri"ate Loan 0nstitutions (PL0PL0s):

Name of PL0PL0s Complete $ddress Contact Number

5)

6)

7)

8)

9)

)

;)

0 further authori3e L$N!'$N2 to:

5) issue a check payable to the PL0PL0s representing the outstanding balance of the loan<

6) remit the checkpayment directly to the PL0PL0s<

7) recei"e the official receipt and Certificate of ,ull Payment from the PL0PL0s< and

8) =pon crediting of loan proceeds> withhold the balance of my payroll account and on the following day of crediting of loan proceeds> withhold up to

amount of the net loan proceeds pending receipt of the Certificate of ,ull Payment and *fficial eceipt from the PL0s&

0 hereby swear that 0 will be responsible to pay in full whate"er difference in the amount of the checkpayment and the latest balance of my e4isting loan

the abo"e PL0PL0s> 0f any&

#ignature *"er Printed Name of 'orrower

APPLICATION/AGREEMENT/PROMISSORY NOTES

0 hereby apply for a Li"elihood Loan in the amount of P.#*# ???????????????????????????????????????????????????????? (P ?????????????

0 hereby swear that: (5) 0 am up-to-date in the payment of my e4isting loans< (6) 0 ha"e no pending application for retirement or are not dueretirement within the ne4t ?????? years from e4ecution hereof< (7) 0 ha"e no pending loan application with other agenciesinstitutions< (8) 0 am a regularperma

employee of the ?????????????????????????????????????????? < (9) 0 am not a respondentparty of any pending administrati"e or criminal cases< () the statements declared abo"e are true and correct to the best of my knowledge and that the application is made for the purpose and consideration e4pre

abo"e& 0 agree that should there be any misrepresentation disco"ered> the Land 'ank of the Philippines may cause the outright disappro"al of the loan applicat

and if the loan has already been granted> L$N!'$N2 may immediately declare the loan due and demandable&

0 promise to pay to L$N!'$N2 the amount applied for in accordance with the terms and conditions printed at the back thereof> which 0 acknowledge to

read and clearly understood&

0 hereby authori3e:

@ the $ccounting !epartment or Collecting *fficer of !ep.d to deduct the monthly installment on this loan from my salary or from any form of bene due me for paymentapplication to the monthly amorti3ation on this Loan> until the loan and all interest and fees related thereon are fully paid&

o e my ayro accoun o& ??????????????????? or paymen app ca on o e mon y amor 3a on on s oan> un

oan an a n eres an ees rea e ereon are u y pa &

@ L$N!'$N2 to inform the !ep.d on the crediting of the loan proceeds and the status of my deposit and loan accounts&

#ignature *"er Printed Name of 'orrower

(To e !"##e$ %& ' E&#o'e)*

*ffice : !ate :

This *ffice certifies that:

(5) the abo"e information and signatures of applicantborrower are authentic<

(6) the abo"e applicant:@ is permanentappointed employee of this *ffice and has been in the ser"ice for at least one year and is not on lea"e of absence without pay<

@ has no pending administrati"e andor criminal charges against him<

@ has no pending application for retirement or is not due for retirement within the term of the loan

@ is up-to-date to the payment of his e4isting loans> if any <

s presen y rece " ng a ne a e ome pay o no ess an ????????????? a er s a u ory e uc ons an ne o a oan o a amor 3a ons

@ including the li"elihood loan applied for&

This *ffice certifies that the net take home pay of the applicantborrower as of ??????????????? amounted to P.#*# ??????????????????????????

????????????????????????????????? (P?????????????)&

This *ffice agrees to collect the monthly installmentamorti3ations due on the loan of the borrower through automatic salary deduction and remit

$PPL0C$NT (First Name, M.I., Surname)

Lo+n O%,,+n$"n.B+#+ne



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Livelihood Loan application Form for DEPED

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