Professional Documents
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Please read the terms & conditions and instructions at the back before accomplishing this form. Print all information in capital letters and use black ink only.
SS NUMBER ADDRESS GENDER Male Female TELEPHONE/MOBILE NUMBER SS NUMBER RELATIONSHIP TO MEMBER
Legal Spouse
(BARANGAY)
(TOWN/DISTRICT)
(CITY/PROVINCE)
POSTAL CODE
Married
Child
4 MEMBER'S CERTIFICATION
I certify that all information provided in this form are true and correct. correct I understand that any false statement in this application or the submission of any falsified document in connection with this loan application shall subject me to criminal prosecution for violation of Section 28 of R.A. 8282 or under the pertinent provisions of the revised Penal Code of the Philippines. Further, I agree to the terms and conditions of this loan as enumerated at the back of this form.
DATE
RIGHT THUMB
RIGHT INDEX
1)
SIGNATURE OVER PRINTED NAME DATE
2)
SIGNATURE OVER PRINTED NAME DATE
SCHOOL'S CERTIFICATION
the following details: Name of course : ________________________________________ Degree Vocational/Technical School year : _____________________ Level : 1st year 2nd year 1st 3 years 3rd year 2nd 4 years 4th year 3rd 5 years 5th year 4th Semester/Trimester/Quarter : No. of years to finish course :
OFFICIAL DESIGNATION
DATE
ENCODED BY :
DATE
DATE
Perforate Here
ACKNOWLEDGEMENT STUB
SS NUMBER
RECEIVED BY :
NAME OF MEMBER
(LAST NAME)
(FIRST NAME)
(MIDDLE NAME)
DATE RECEIVED
RECEIVING BRANCH
DESIGNATION
II.
III.
INSTRUCTIONS
1) Member to fill out Member Details. 2) Member must file application for educational assistance loan program personally and must present his Social Security card. In the absence of the Social Security card, member is advised to apply immediately for said card and present two valid IDs, one with photo and signature. 3) If filed by members representative, the member's representative must present the following: (1) his Social Security card or any two of the following IDs: unexpired drivers license; PRC card; passport; postal ID; school or company ID; Tax Identification Number card (TIN); (2) borrowers Social Security card and authorization letter (signed by both member and the representative).