Republic of the Philippines

DepED Provident Fund

Meralco Ave., Pasig City

Date Applied: Loan Application No.

Loan Amount: Purpose:

o Educational
Type of Loan: Term: year/s o Hospitalization/Medical
o Regular o House Arrears / Equity
o New o House Repair - Major
o Renewal o House Repair - Minor
o Calamity o Long Medication/Rehabilitation
o Special o Payment of Loans from Private Institution
o Additional o Others (specify)
Borrower's Information Co-Maker's Information

(Surname) (First Name) (M.I.) (Surname) (First Name) (M.I.)

Home Address: Home Address:

Position: Position:
Employee No.: Status: Employee No.: Status:
Office: Code: Office: Code:
Date of Birth: Age: Date of Birth: Age:
Monthly Salary: Salary Grade: Monthly Salary: Salary Grade:
Years in Service: Leave Credits: Years in Service: Leave Credits:
Specimen Signature: Specimen Signature:

AGREEMENT

I hereby apply for Provident Fund Loan in the amount of I hereby agree to assume all the outstanding obligations
P________ and at the amortization schedule stated below. for the grant of this loan should the principal borrower be
In consideration of the grant thereof, I promise to pay all separated from the service and that retirement nor
installments due and bind myself with the terms and separation benefits due him/her is not received or is not
conditions of the loan. sufficient to settle the borrower's outstanding loan, and
upon proper notification by the Provident Fund Secretariat.
Accordingly, I hereby authorize the deductions of the
monthly amortizations from my salary. Should I be Accordingly, I hereby authorize the monthly deduction
separated from the service, I also hereby authorize the from my salary of the amortizations for the outstanding
deduction in full of any unpaid balance from my retirement obligation of the principal borrower until his/her loan has
or separation benefits been fully paid.

Signature of Borrower Date Signature of Co-Maker Date

over Printed Name over Printed Name

Amortization Schedule
Amount of Loan o 12 mos. o 24 mos. o 36 mos. o 48 mos. o 60 mos.
o Php 5,000.00 416.67 208.33
o 10,000.00 833.33 416.67
o 20,000.00 1666.67 833.33 555.56
o 30,000.00 2500.00 1,250.00 833.33 625.00 500.00
o 40,000.00 3333.33 1,666.67 1,111.11 833.33 666.67
o 50,000.00 4166.67 2,083.33 1,388.89 1,041.67 833.33
o 100,000.00 4,166.67 2,777.78 2,083.33 1,666.67
Select (ü) the preferred loan amount and amortization schedule subject to computation of Net Take Home Pay.

Authorization for Salary Deduction

Personnel Division
DepED , Meralco Ave., Pasig City

I hereby authorize
(P____________) the deduction
from my salary of ______________________________________________________________
for ______ months, starting in ___________________. 20___ to __________________,PESO
20
___
or until my total outstanding loan of _____________________________________________________________________
PESOS
(P_______________) has been fully paid. Amount deducted shall be credited to the account of the DepED Provident Fund as
receivables on the said loans.

Signature over Printer Name

Employee No. Status: Designation:
Division: Code: Service:
 Republic of the Philippines
Department of Education
Provident Fund

Date Submitted: Loan Application No.

Loan Amount: PhP Purpose:

o Educational
Type of Loan: Term: year/s o Hospitalization/Medical
o Multi-purpose o House Arrears / Equity
o New o House Repair - Major
o Renewal o House Repair - Minor
o Additional o Long Medication/Rehabilitation
o Payment of Loans from Private Institution
o Calamity
o Others (specify) ___________________________
Borrower's Information Co-Maker's Information

(Surname) (First Name) (M.I.) (Surname) (First Name) (M.I.)

Home Address: Home Address:

Position: Position:
Employee No.: Employment Status: Employee No.: Employment Status:
Office: Office:
Date of Birth: Age: Date of Birth: Age:
Monthly Salary: PhP Office tel. no. Monthly Salary: PhP Office tel. no.
Years in Service: Mobile no. Years in Service: Mobile no.
DepEd E-mail address: ______________________________
Specimen Signatures: Specimen Signatures:

LOAN AGREEMENT
I hereby apply for a Provident Fund Loan in the amount of PESOS: I hereby agree to assume all the outstanding obligations for the grant
______________________________ (P __________). In of this loan should the principal borrower be separated from the
consideration of the grant thereof, I promise to pay all installments service and either retirement or separation benefits due him/her is
due based on the attached amortization schedule and bind myself not received or is not sufficient to settle the borrower's outstanding
with the terms and conditions of the loan as stipulated in the loan, and upon proper notification by the Provident Fund Secretariat.
applicable guidelines of the DepEd Provident Fund. This document
also serves as Promissory Note upon approval of this loan. Accordingly, I hereby authorize the monthly deduction from my salary
of the amortizations for the outstanding obligation of the principal
Accordingly, I hereby authorize the deductions of the monthly borrower until his/her loan is fully paid.
amortization from my salary. Should I be separated from the service,
I also hereby agree to settle my outstanding loan balance before the
date of my retirement/separation from the service, either through full
payment in cash, or through the execution of a notarized Promissory
Note.

Signature of Borrower Date Signature of Co-Maker Date

over Printed Name over Printed Name

CERTIFICATE OF EMPLOYMENT AND CREDIBILITY

Name: Date:
Office:

Personnel Division: Legal Service:

This is to certify that the above loan applicant: This is to certify that the above loan applicant/borrower has no
(1) is a ___ permanent/___ co-terminus employee of this Office pending administrative case charge against him/her based on the
and is not on leave of absence without pay; records on file with DepEd.
(2) has net pay of PhP_____________ for the payroll month &
year of ____________________; and
(3) has given the true and correct information on the Loan
Application Form.

ROSAURO C. BELEN ATTY. REDENTOR M. AGUSTIN

Signature over Printed Name Signature over Printed Name
Attorney III
Designation Designation
 SECRETARIAT'S ASSESSMENT/EVALUATION

A. Documents Submitted: (Two copies of each)

o Loan Application Form (LAF) - two (2) copies o Additional documents for Additional Loan:
o Authorization to Deduct o Letter Request
o Latest copy of payslip o Hospitalization/Medical Expenses
o Photocopy of DepEd ID o Medical Abstract/Certificate/Prescription/
o Approved appointment (for FIRST TIME borrowers and Diagnosis
Co-Terminous Employees Only) o Barangay/LGU certificate/resolution declaring
o Document showing proof that the co-terminous employee the Borrower's place under State of Calamity
has rendered at least 2 years service in DepEd, e.g. notarized Reviewed by: Date:
o Others (specify) JAQUELYN R. ATTABAN

B. Completeness and Veracity of Submitted Documents:

o Signed and completely filled out LAF
o Complete supporting documents for type of loan applied for
o Signatures on LAF are by authorized signatories Reviewed by: Date:
JAQUELYN R. ATTABAN

C. Eligibility of the Borrower and Co-Maker

o Borrower will not reach the mandatory age retirement on or before the maturity of his/her loan. Age:
o Co-Maker will not reach the mandatory age retirement on or before the maturity of his/her loan. Age:
o Borrower has Outstanding PF Loan Balance:
o Current Loan Balance Amount: PhP
o Past-Due Loans Amount: PhP
o No. Of Years/Months Past-Due: Year/s: Month/s:
o Borrower's Net Take-Home Pay after deduction of monthly amortization of the loan being applied for
is equal to or higher than the required threshold for the current year.
o For renewal of loans: Borrower has paid at least 30% of the principal of the existing loan.
Percentage of principal paid: % Verified by: Date:
JAQUELYN R. ATTABAN

D. Computation of Loan:
Amount of Loan applied for PhP Net Take Home Pay after
Less: Previous Loans Deduction: PhP:
Principal PhP Monthly Amortization PhP:
Interest Period of Loan (mm/yy - mm/yy)
Net Proceeds PhP Date Processed:

Processed by: JAQUELYN R. ATTABAN Remarks:

Signature over Printed Name
(Secretariat)

Reviewed by: XYZA C. ZINGAPAN

Signature over Printed Name
(Head, PF Secretariat)

ACTION TAKEN:

Recommending Approval: o Approved

o Disapproved

XYZA C. ZINGAPAN
Head, PF Board Secretariat REYNANTE Z. CALIGUIRAN
Signature over Printed Name Schools Division Superintendent
Chairperson of the Board
Date: _____________________ Signature over Printed Name
Date: _____________________
 Authorization for Salary Deduction

Personnel Section
DepEd, SDO Cagayan

I hereby authorize the deduction of ______________________________________________________________ PESOS

(P____________) from my salary for ______ months, starting in ___________________. 20___ to
__________________, 20 ___ or until my total outstanding loan of ____________________________________ PESOS
(P_______________) has been fully paid. Amount deducted shall be credited to the account of the DepED Provident Fund as
receivables on the said loans.

Signature over Printer Name

Employee No.__________ Status: Designation:
Division:______________ Code: Service:

AUTHORIZATION FOR SALARY DEDUCTION

Personnel Section
DepEd SDO Cagayan

I hereby authorize the deduction of _________________________________________________________ PESOS

(P____________) from my salary for ______ months, starting in ___________________. 20___ to ____________________
, 20 ___ or until my total outstanding loan of _______________________________________ PESOS (P________________
has been fully paid. Amount deducted shall be credited to the account of the DepED Provident Fund as receivables on the
said loans.

Signature over Printer Name

Employee No. Status: Designation:
Division: Code: Service:

Amount of Loan (12 months) (24 months) (36 months) (48 months) (60 months)
( ) 100,000.00 8,606.65 4,432.07 3,042.20 2,348.51 1,933.29
( ) 90,000.00 7,745.98 3,988.86 2,737.98 2,113.66 1,739.96
( ) 80,000.00 6,885.32 3,545.65 2,433.76 1,878.81 1,546.63
( ) 70,000.00 6,024.66 3,102.45 2,129.54 1,643.96 1,353.30
( ) 60,000.00 5,163.99 2,659.24 1,825.32 1,409.11 1,159.97
( ) 50,000.00 4,303.33 2,216.04 1,521.10 1,174.26 966.65
Checklist of Application Forms Submitted
As of May 31, 2016

Applic-
Regions Application Form Data Division ation Authorization Certificate of Certification of Secretariat Assessment
Application Amort.
Form Loan Info. Borrower's Data Co-Maker's Data for Salary Employment & Prov. Fund Loan /Checklist/ Requirement
Agreement Schedule
Deduction Credibility for PF Loan

Documents Submitted:
1.) Application Form
(3 copies)
ŸŸ ŸApplication No. Borrower's Name Co-Maker's Name
Monthly 2.) Payslip of Borrower
Ÿ Type of Loan (New/ Present Address Present Address
Amortization deduction, and co-maker, (Last 2
Renew; Position Position
Sched./Table period/term, Indorsing months)
Regular/Special) Employee No. Employee No. Signature,
Loan Amount Signature, Officials from 3) Statement of Account/
Ÿ Purpose (Educa- Date of Birth Date of Birth Employee No. and
(P5K, 10K, 20K, Employee No., Personnel & Bill or Official Receipt/
CO ü ational, Housing Office Office date signed of none
30K, 50K, Position, Legal Div. Proof of Payment
Arrears, Medical/ Monthly Salary Monthly Salary Borrower & Co-
P100K) Division, (Signature and 3) Bills of Mats./Labor
Hospitalization, Status Status Maker
Term (12 , 24, Strand/Office position) 4) Doctor's Medical
Payment of PLI Loans, No. of Yrs. In Service No. of Yrs. In Service
36, 48, 60 mos.) and Status of Certificate/Prescription/M
House Repair- Minor/ No. of Leave Credits No. of Leave Credits
Borrower edical Abstract
Major, Others) 2 Specimen Signature 2 Specimen Signature
Loan computation
Signature of Borrower
5)

Same info., Certify that loan is

Amortization used for the ff.
Same info., excluding Same info., excluding
ŸŸ Application No. Sched./Table Purpose (emergency,
no. of years in service no. of years in service Indorsing
ŸŸŸ Type Loan (New, indicated. educational, loss of no computation
and leave credits, and leave credits, Officials of
I ROP, La Union ü Renew, Calamity); and Loan Amount Same income of spouse, (reason: choose from the
instead instead Chief Adm.
Ÿ Former Station P2K - 5K (by 1K), calamity) amort. Sched.)
TIN, Station and Div. with TIN, Station and Officer
8K, 10K, P___K) Reason (Tuition fees,
No. was Div. No.
Term (12 , 24, 36 Medical expenses,
mos.) Others)

Same info.,
Amortization
Same info., excluding Same info., excluding
Sched./Table Certify that loan is
no. of years in service no. of years in service
indicated. Indorsing used for the ff. no computation
and leave credits, and leave credits,
II ROP, Tuguegarao ü none Loan Amount none Officials/Head Purpose (emergency, (reason: choose from the
instead instead
P15K - 50K (by 5K), of Office educational, calamity, amort. Sched.)
with TIN and Bank with TIN and Bank
P100K others)
Account No. Account No.
Term (12 , 24, 36,
60 mos.)

Loan Amount
Regular - P5K,
Same info., excluding Same info., excluding 8K, 10K, 15K
Same info., Amort. Request form
no. of years in service no. of years in service Term (12, 24
Sched./Table, Type for Salary
Application No. and leave credits, and leave credits, mos.) Purpose (emergency,
SDS Nueva Vizcaya ü of Loan Term Deduction, none
Type (New/ Renew) instead instead Special - 20K, educational, calamity)
indicated here. stoppage, or
with TIN and Bank with TIN and Bank 25K, 30K, 40K,
adjustment.
Account No. Account No. 50K, 100K
Term (12 , 24,
36, 60 mos.)

III ROP, San Fernando ü

IV-A ROP, Cainta, Rizal ü
IV-B ROP, Meralco, Pasig ü

ŸŸ ŸApplication No. Borrower's Name Co-Maker's Name

Ÿ Type of Loan (New/ Present Address Present Address
Amortization
Renew; Position Position
Sched./Table
Regular/Special) Employee No. Employee No. Signature,
Loan Amount
Ÿ Purpose (Educa- Date of Birth Date of Birth Employee No. and
(P5K, 10K, 20,
V ROP, Legazpi City ü ational, Housing Office Office date signed of
K, 30K, 50K,
Arrears, Medical/ Monthly Salary Monthly Salary Borrower & Co-
P100K)
Hospitalization, Status Status Maker
Term (12 , 24,
Payment of PLI Loans, No. of Yrs. In Service No. of Yrs. In Service
36, 48, 60 mos.)
House Repair- Minor/ No. of Leave Credits No. of Leave Credits
Major, Others) 2 Specimen Signature 2 Specimen Signature

VI ROP, Iloilo ü
VII DO Bohol ü
VIII ROP, Leyte ü
DO Northern Samar ü
IX ROP, Zamboanga ü
X
DO Tangub ü
DO Mis. Oriental ü
XI ROP, Davao City ü
XII
CARAGA ROP, Butuan City ü
CAR ROP, Benguet ü
NCR
DO Rizal ü
NIR
 Acknow-
Action Taken Remarks
ledgment

Approved/
Disapproved
(Signed by
Heads of
Secretariat and
Chairman)

Approved/
Disapproved
(Signed by none
RD/ARD of RO
Secretariat)

Approved/
Disapproved
Bank Acct. No.
(Signed by RO none Loan Amount from P15-50k, P100K
Head
Secretariat)

Approved/
Disapproved
(Signed by RO
Head
Secretariat)

TIN, 2 addresses (Present and Home)

Amort. Sched. 12, 24, 36, 48 & 60 mos.

Loan Amount fr P15-50k, P100K

Loan Amount fr P15-50k, P100K