Republic of the PhilippinesSOCIAL SECURITY SYSTEM MEMBER LOAN APPLICATION (12-2012) Please read the terms & conditions, instructions at the back of the form, and the attached sheet on Documentary Requirements for Salary Loan Application before accomplishing this form. Print all information in capital letters and use black ink only. PART I - TO BE FILLED OUT BY THE MEMBER SS NUMBER ADDRESS (NO. & STREET) NAME (SURNAME) (GIVEN NAME) (MIDDLE NAME) (BARANGAY) (TOWN/DISTRICT) (CITY/PROVINCE) POSTAL CODE TELEPHONE/MOBILE NUMBER LOAN TYPE SALARY CALAMITY PREFERRED MODE OF PAYMENT E-MAIL ADDRESS (IF ANY) TIN AMOUNT APPLIED FOR EMERGENCY NAME OF BANK/BRANCH OTHERS Check Cash Card ATM/Passbook SAVINGS/CASHCARD ACCOUNT/PACKAGE UNIT NUMBER BRANCH ROUTINE SYMBOL TRANSIT NUMBER (BRSTN) (To be filled out by SSS) MEMBER'S CERTIFICATION I certify that the information provided in this form are true and correct. Also, I agree with the terms and conditions of this loan as enumerated at the back of this form. SIGNATURE OF MEMBER-BORROWER DATE RIGHT THUMB RIGHT INDEX (If member-borrower cannot sign, fingerprints should be affixed and witnessed by two persons) WITNESSES TO FINGERPRINTS Please affix signature over printed name and indicate date 1) SIGNATURE OVER PRINTED NAME DATE 2) SIGNATURE OVER PRINTED NAME DATE PART II - TO BE FILLED OUT BY THE EMPLOYER EMPLOYER NUMBER ADDRESS (NO. & STREET) (BARANGAY) NAME OF EMPLOYER/REGISTERED BUSINESS NAME (TOWN/DISTRICT) (CITY/PROVINCE) POSTAL CODE TELEPHONE/MOBILE NUMBER E-MAIL ADDRESS TIN EMPLOYER'S CERTIFICATION I certify that the information provided in this form are true and correct. Also, I agree with the terms and conditions of this loan as enumerated at the back of this form. SIGNATURE OVER PRINTED NAME OF EMPLOYER/AUTHORIZED REPRESENTATIVE OFFICIAL DESIGNATION DATE PART III - TO BE FILLED OUT BY SSS IDENTIFICATION/DOCUMENT(S) PRESENTED: SS ID card Two valid IDs, one with photo and signature Other documents ______________________________________ REVIEWED BY RECEIVED AND ENCODED BY SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE Perforate Here MEMBER LOAN APPLICATION ACKNOWLEDGEMENT STUB SS NUMBER RECEIVED BY NAME OF MEMBER (SURNAME) (GIVEN NAME) (MIDDLE NAME) DATE RECEIVED RECEIVING BRANCH SIGNATURE OVER PRINTED NAME DESIGNATION Note: Verification of status may be made after _____ working days upon receipt of application. For those registered with the SSS website, you may verify thru www.sss.gov.ph retirement and death. the member-borrower must have thirty six (36) posted monthly contributions. 2. Truth in Lending Act). SERVICE FEE A service fee of 1% of the loan amount shall be charged and deducted from the proceeds of the loan. his employer must be updated in contributions and loan remittances.which is due on or before the payment deadline for loans per Circular No. G. whichever is lower. The member-borrower must be under sixty-five (65) years of age at the time of application (SSC Res. one with photo and signature. the member-borrower must have seventy two (72) posted monthly contributions. If the member-borrower is employed.. For self-employed/voluntary member. REPAYMENT TERM AND SCHEDULE OF PAYMENT 1. The employer shall require a new employee to secure from the SSS an updated statement of his account. A disclosure statement on loan transaction shall be issued by SSS to the member-borrower upon approval of his loan (R. The member-borrower shall notify the SSS in case of change of address/employer thru mail/e-mail/over-the-counter (OTC). rounded to the next higher monthly salary credit. E.3765. 5. based on diminishing principal balance. C. H. Member Assistance for the Development of Entrepreneurship (MADE) and housing loans granted under the Unified Housing Loan Program (UHLP) or direct from SSS. (2) borrower's Social Security card and letter of authorization (LOA) signed by both member-borrower and the representative. (e. passport. AS AMENDED) OR APPLICATION FOR LOAN WITH THE SSS SHALL BE LIABLE CRIMINALLY UNDER SECTION 28 OF R. A two-month salary loan is equivalent to twice the average of the member’s latest posted 12 Monthly Salary Credits (MSCs). The employer shall deduct the total balance of the loan from any benefit/s due to the employee and shall remit the same in full to SSS. total permanent disability. 2. RESPONSIBILITIES OF EMPLOYER 1.A. 2. The member-borrower has not been granted final benefit. The member-borrower must be updated in the payment of his obligations in his member loans. 8282 OR UNDER PERTINENT PROVISION OF THE REVISED PENAL CODE OF THE PHILIPPINES. interest shall continue to be charged on the outstanding principal balance until fully paid. INSTRUCTIONS 1) Member-borrower to fill out Part I.1 For a one-month loan. and duly signed by the member-borrower (in case of mail/OTC). the member's representative must present the following: (1) his Social Security card or any two of the following IDs: unexpired driver's license. All subsequent remittances shall be made on or before the payment deadlines for loans following the applicable month. 2. 5) If filed by employer's representative. LOAN RENEWAL 1. educational. whichever comes first. currently contributing self-employed or voluntary member is qualified to avail of the salary loan program: 1. The member-borrower has not been disqualified due to fraud committed against the SSS. . whichever is lower. through the collection list. F. at any SSS branch with f SSS SSS with tellering facility. retirement or resignation) or involuntarily. D.A. 2) Employer to fill out Part II. The loan shall be charged an interest rate of 10% per annum until fully paid.g. Only currently employed. 1161. 1. six (6) of which should be within the last twelve (12) months prior to the month of filing of application. 3.e. Tax Identification Number card (TIN). 2. Any overpayment on a previous loan shall be applied to the subsequent loan. school or company ID. 2. 4. 2. Any excess in the amortization payment shall be applied to the outstanding principal balance. WARNING ANY PERSON WHO MAKES ANY FALSE STATEMENT IN THIS APPLICATION OR SUBMITS ANY FALSIFIED DOCUMENT IN CONNECTION WITH ANY CLAIM FOR ANY BENEFIT PAYABLE UNDER THE SOCIAL SECURITY ACT LAW (R. deduction shall be from short-term benefits (Sickness/Maternity/Partial Disability). Loan amortization not remitted on due date shall bear a penalty of 1% per month until fully paid. ELIGIBILITY REQUIREMENTS 1. and shall be amortized over a period of 24 months. 6. six (6) of which should be within the last twelve (12) months prior to the month of filing of application. 3. the arrearages/unpaid loan shall be deducted from the benefits claimed by the member. If the loan is not fully paid at the end of the term. emergency.2 For a two-month loan. DEDUCTION OF UNPAID LOAN FROM BENEFITS In case of default.g. and his Social Security card. 434 dated 09 November 2005). The employer shall deduct and remit to SSS any outstanding loan balance of new employees. termination of employment or cessation of operations of the company). 3. RESPONSIBILITY OF MEMBER-BORROWER A member-borrower who transfers employment is obliged to report to the new employer any outstanding loan balance with SSS and shall allow the new employer to deduct from his salary the corresponding amortization due.PRC card. (e. i. 1. in case the member-borrower is separated voluntarily. which include salary.A. The notice should indicate the name and SS number of the member-borrower. The one-month or two month salary loan shall be payable within two (2) years in 24 monthly installments to start on the 2nd month following the date of loan. Renewal shall be allowed after payment of at least 50% of the original principal amount and at least 50% of the term has lapsed.borrower's representative. Automatic deduction of outstanding loan balance from final benefits (Total Disability/Retirement/ Funeral/Death). 3. SSS accredited banks or SSS authorized payment centers. if the benefit(s) due the employee is insufficient to fully repay his loan. 4) If filed by member.2011-003. member-borrower is advised to apply immediately for said card and present two valid IDs. plus any interest/penalty for late remittance of amortization. 3) Member-borrower may file the salary loan application personally and must present his Social Security card. INTEREST AND PENALTY 1. stock investment. postal ID. In the absence of the Social Security card. The employer shall be responsible for the collection and remittance to the SSS of the amortization due on the member-borrower’s salary loan through payroll deduction. No. addressed to the Member Services Section of the nearest SSS branch. as follows: 1.TERMS AND CONDITIONS A. The employer shall report to the SSS the effective date of separation from the company and the unpaid loan balance of the employee. OTHER CONDITIONS 1. I. B. 5. LOAN AMOUNT A one-month salary loan is equivalent to the average of the member’s latest posted 12 Monthly Salary Credits (MSCs). or amount applied for. calamity. or amount applied for. the employer's representative must present authorized company's representative (ACR) card issued by SSS or letter of authorization (LOA) from employer. 4. J.