Revised Jan 2011

AFPMBAI
SALARY LOAN/MEDAL APPLICATION FORM
(02)911-4051 to 58/(02)911-8040 to 44/0920-952-6224

IMPORTANT: PLEASE READ INSTRUCTIONS, TERMS AND CONDITIONS AT THE BACK BEFORE FILLING OUT. PRINT ALL INFORMATION IN CAPITAL LETTERS.

REQUIREMENTS ORIGINAL LATEST PAYSLIPS FOR THREE (3) CONSECUTIVE MONTHS Updated CERTIFICATE of NON-PENDING CASE (valid for 30 days only). For PA - DLO CLEARANCE (HPA) FOR PNP - IAS (Internal Affairs Service) CLEARANCE -CRAME NTHP: PNP, BFP, PCG, CE (P 3,200.00); BJMP (P4,000.00); GHQ, PN, PAF (P5, 700.00); PA (P 6,900.00) For PNP, BFP, BJMP, and Officers AFP & PCG - Updated STATEMENT of SERVICE RECORD (and Permanent Appointment Order-KSS / Attestation for New PNP, BFP, and BJMP Graduates/Trainees) FOR Civilian Employees Certificate of Permanent Employment and Permanent Order (Civil Service Commission) For CE of AFP, GHQ, PNP, BFP, BJMP, PCG plus Certificate of Non-Inclusion in Mass Lay-off/Rationalization For PCG & AFP (Enlisted must be at least one (1) year in service as ordered by Finance Center) - Current Enlistment/Reenlistment Order (if ETE/Date of Discharge expires w/in 2 yrs submit also Certificate of Recommendation for Re-enlistment from Re-enlistment Board or Willingness to Re-enlist)

SALARY MEDAL NEW RENEWAL

PICK UP HEAD OFFICE FOR DEPOSIT MAILING BANK/BRANCH __________________ PICK UP REGIONAL _________________ ATM/ACCT. NO. _________________
SALARY LOAN/MEDAL AGREEMENT

KNOW ALL MEN BY THESE PRESENTS: I, the Borrower hereby apply for a Salary loan/MEDAL. In consideration thereof, I promise to pay the TOTAL LOAN AMOUNT to the ARMED FORCES AND POLICE MUTUAL BENEFIT, INC. (AFPMBAI), in accordance with the terms and conditions printed at the back hereof which I have read and understood clearly and to which I bind myself to pay the correct MONTHLY AMORTIZATION for which I hereby authorize our Treasurer/Disbursing or Collecting Officer to deduct from my salary. Moreover, all arrearages that I may incur of this Salary/MEDAL loan, I hereby authorize the AFPMBAI to deduct from any future claim or benefit (cash values, maturities, termination, etc.) due me. And in case of my retirement or separation from the service, the AFPMBAI is fully authorized to collect from my separation/retirement benefits the unpaid balance of this Salary loan/MEDAL.

SIGNATURE:

___________________________ Birth Date: _____________ Age: _____ Contact No. ___________________

Name: Last_______________________________ First_______________________________ Middle_______________________ Rank, SN, Branch of Service, Unit Assignment: __________________________________________________________________ Complete Home Address: ____________________________________________________________________________________ Complete Provincial Address: ________________________________________________________________________________ Policy Number/s and Face Amount: ____________________________________________________________________________ _________________________________________________________________________________________________________ Loan Amount: _____________________________ Term of Payment:_____________ months
=============================== FOR FILL OUT OF DIVISIONS CONCERNED =================================

1.

RECORDS
(West Wing)

3. BILLING AND COLLECTION DIV

(5TH Floor)

4.

CLAIMS DIVISION
(Counters 6 to 11)

NTHP before loan P____________ Mo. Covered _________________ Less this loan P_______________ NTHP P_____________________ SL ________________________ Verified by: ___________ SPSL (Kawal Kalinga)_________ Noted by: _____________ OPL ______________________ E56 PL ___________________ E-56 _____________________ 2. FINGER SCANNING AI _______________________ (Ground Floor Lobby) BPL ______________________ With Finger Scan MEDAL ___________________ No Finger Scan CALAMITY________________ BASIC PREM _____________ Verified by: ______________ Verified by: _________________ Date: ___________________ Date: ______________________ DUE DATE / TIME Refer To CLAIMS : _________________________

Similar Different No Record on File

Outstanding Accounts: a. Opt. Ins. _____________________ b. Opt. Pol. Loan _____________________ c. Basic Pol. Loan _____________________ d. E-56 _____________________ e. E-56 Pol Loan _____________________ f. Salary Loan _____________________ g. SPSL (Kawal Kalinga)_________________ h. Appliance Loan _____________________ i. Calamity Loan _____________________ j. MEDAL _____________________ k. REHL _____________________ l. REML _____________________ m. Acted as Co-Maker to:_________________
Salary Loan__________________________________ MEDAL ___________________________________ Calamity Loan________________________________ Appliance Loan_______________________________

m. Members Status _____________________

Verified by: _________________________ Noted by: ___________________________

GUIDELINES IN GRANTING SALARY LOAN and MEDAL

A. ELIGIBILITY 1. The member/borrower must have an active and current additional insurance and/or E56 with the Association for Salary Loan which is enforced for at least one (1) month at the time of application. For Members Educational Loan (MEDAL) all regular and associate members who have existing Basic Insurance, Additional /E56 insurance or SGTI coverage. However, associate members must be permanently employed. The premium payment should have been made through salary deduction and remitted to the Association. 2. The existing Premiums, Policy Loans, Real Estate Loans, (MEDAL), Calamity Loans, Appliance Loan, and other accounts of the member/borrower with the Association should be current and updated as to payment with NO ARREARS nor DORMANT ACCOUNT. In addition, a borrower must have a good credit record as may be determined from any credit bureau/facility established for this purpose. 3. The member/borrower should have a NET TAKE HOME PAY after the deduction of the monthly amortization of this salary loan and medal as may be required by the branch of service/bureau. 4. Only one (1) Salary Loan and one (1) MEDAL shall be entertained at any one time regardless of the no. of Policies held. B. LOAN AMOUNT 1. A qualified member may apply for a maximum principal amount of P200,000.00 for Salary Loan and P50,000.00 for MEDAL, but in no case shall the GROSS LOAN/TOTAL LOAN AMOUNT(Principal amount + interest) exceeed the face amount of his policy/s.

C. INTEREST RATE, PENALTY CHARGE, AND PROCESSING FEE 1. Salary Loan shall be charged an interest rate of 8% per annum, add on interest while MEDAL shall be charged an interest rate of 7% per annum, add on interest. 2. Salary Loan and MEDAL amortization not paid on the due date shall bear a penalty of 1% per month. 3. 1st monthly amortization shall be due on the 3rd month following the month of loan release. For the institutional delay, a 2-months interest computed on simple interest method shall be deducted from the loan proceeds. 3. A processing fee equivalent to 1% of the principal loan shall be deducted from the loan proceeds. D. PAYMENT TERM The term of payment for Salary Loan shall not be BEYOND twenty four (24) months (for P60,000.00 and below) or thirty six (36) months (for above P60,000.00) from date of application, or his retirement date, or the maturity of the longest policy in effect, whichever comes first. For MEDAL the payment term shall not be beyond 12 months. E. LOAN INSURANCE 1. Salary Loan shall automatically be covered by Salary Loan Redemption Insurance (SLRI) to be deducted from the loan proceeds. Premium to underwrite this insurance shall be P 4.15 per thousand of the original amount of the loan for a Salary Loan payable within six (6) months, P 5.82 for one (1) year, P 11.30 for two (2) years, and P 16.57 for three (3) years. The SLRI shall be deducted from the proceeds of the loan. 2. MEDAL Loan shall be covered by Credit Redemption Insurance (CRI) to be deducted from loan proceeds. Premium to underwrite this insurance shall be P 4.15 per thousand of the original amount of the loan for a loan payable within six (6) months and P 5.82 for one (1) year. 3. In case of the death of the borrower, the Claims Division shall determine the amount to be indemnified which shall be the theoretical balance of the loan at the time of death this being the loan balance assuming that installment payment has been paid when due. Any arrearages, penalties and surcharges shall be deducted from any benefit due the borrower. F. LOAN RENEWAL 1. Salary loan may be renewed after payment of at least 6 remitted monthly amortization made through salary/payroll deduction. 2. A member borrower of good credit record (regularly paying his/her monthly amortization) may renew his/her MEDAL after payment of at least 6 remitted monthly amortization made through the approved mode of payment. 3. The remaining loan balance shall be deducted from the proceeds of the loan renewal if loan payment is current and updated. WARNING: Direct or Indirect commission of fraud, collusion, falsification, misrepresentation of facts or any other kind of anomaly in the accomplishment of this form, or in obtaining any benefit or payment under this application shall be subject to administrative and/or criminal action.

INSTRUCTIONS If a representative will claim the check, attach SPA for Salary Loan or Authorization for Medal, and 2 valid ID. If check remains unclaimed one month after the due date, it will be mailed to his address.

PROCEDURE IN FILING OF THIS LOAN

1. GET a QUEUEING NUMBER at the CUSTOMER SERVICE & FILL UP THIS APPLICATION FORM 2. PROCEED TO MEMBERSHIP SECTION. 3. If filed or for pick-up by a REPRESENTATIVE, proceed to RECORDS (WEST BLDG) 4. WAIT for your NUMBER to be SERVED at COUNTERS 6, 7, 8, 9, 10, or 11.

PROMISSORY NOTE
For value received, I hereby promise to pay the AFP Mutual Benefit Association, Inc. (AFPMBAI) the total loan amount of _____________________________________________________________ PESOS (P______________________) Philippine Currency, with interest rate of 8% for Salary Loan and 7% for MEDAL per annum, payable within a period of ______________________ (_______) months and on the basis of the foregoing, I hereby authorize our Treasurer/Disbursing or Collection Officer to deduct from my salary and/or allowance the monthly amortization in the amount of __________________________________________________________________________ PESOS (P_______________), starting on or before ________________ 20___ until the total amount of the loan plus interests thereon shall have been fully paid and until the full satisfaction of my obligation. It is understood that in case of default on my part to pay three (3) monthly amortizations, the AFPMBAI shall have the option to declare the outstanding balance of the loan due and demandable. It is further understood that if for any reason my Treasurer/Disbursing or Collecting Officer fails to deduct from my salary the monthly amortization due, I shall directly remit the said amount to the AFPMBAI on or before the fifth of the following month. Otherwise, the amortization due and unpaid shall bear an additional interest of one percent (1%) per month of delay until actually paid. It is further understood that in case of my retirement or separation from the service, I authorize AFPMBAI to collect thru the Disbursing or Collection Officer by deducting the loan balance from any of my retirement/separation benefits. In case of loan renewal, payments for my old loan that have not been considered in my loan renewal should be automatically credited to my new account/loan. Quezon City, ________________20___. ________________________________________ Borrowers Signature Over Printed Name =============================================================================================

COPY FOR AMD

AUTHORIZATION TO DEDUCT SALARY LOAN/MEDAL

Policy No.____________________ TO: CO, FINANCE CENTER Sir: For and in consideration of the Salary Loan/MEDAL granted to me by the AFP MUTUAL BENEFIT ASSOCIATION, INC. in the amount of P_______________________________, I hereby authorize you to deduct from my salary the amount of P________________________ for the period of ___________ months. And in case of my retirement or separation from the service, I further authorize you to deduct from my separation/retirement benefits the unpaid balance of this Loan. I agree that no other request on my part shall exempt me from the responsibility of seeing to it that the corresponding deductions are promptly and religiously effected and remitted to AFPMBAI as they become due. (BORROWER) SIGNATURE:______________________________________ DATE_________________20_________ NAME: ____________________________________________________ Rank, SN, Br of Svc____________________________ (Please Print Legibly) First Name MI Last Name UNIT ASSIGNMENT: ____________________________________________________________________________________ UNIT CODE: _____________________________________ ACCOUNT NO.: ________________________________________ NAME PER PAYSLIP:___________________________________________

COPY FOR BCD

AUTHORIZATION TO DEDUCT SALARY LOAN/MEDAL

Policy No.____________________ TO: CO, FINANCE CENTER Sir: For and in consideration of the Salary Loan/MEDAL granted to me by the AFP MUTUAL BENEFIT ASSOCIATION, INC. in the amount of P_______________________________, I hereby authorize you to deduct from my salary the amount of P________________________ for the period of ___________ months. And in case of my retirement or separation from the service, I further authorize you to deduct from my separation/retirement benefits the unpaid balance of this Loan. I agree that no other request on my part shall exempt me from the responsibility of seeing to it that the corresponding deductions are promptly and religiously effected and remitted to AFPMBAI as they become due. (BORROWER) SIGNATURE:______________________________________ DATE_________________20_________ NAME: ____________________________________________________ Rank, SN, Br of Svc____________________________ (Please Print Legibly) First Name MI Last Name UNIT ASSIGNMENT: ____________________________________________________________________________________ UNIT CODE: _____________________________________ ACCOUNT NO.: ________________________________________ NAME PER PAYSLIP:__________________________________________