HQP-SLF-065

MULTI-PURPOSE LOAN (MPL) (V06, 08/2021)

APPLICATION FORM Pag-IBIG MID NO./RTN APPLICATION NO.
(To be filled out by applicant. Print this form back to back on one single sheet of paper)
Type or Print Entries 1211 8970 5694
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME MAIDEN MIDDLE NAME NO MIDDLE NAME DATE OF BIRTH PLACE OF BIRTH
(e.g., Jr., II) (for married women) (check if applicable only)
BARCELLANO, JELANE AMOURELLE AQUINO  APRIL 3, 1982 TUGUEGARAO CAGAYAN
COMPLETE MOTHER’S MAIDEN NAME (Required) NATIONALITY SEX MARITAL STATUS CITIZENSHIP EMAIL ADDRESS
 Male  Single  Widow/er  Annulled
 Female  Married  Legally Separated FILIPINO [email protected]
PRESENT HOME ADDRESS (Required) Unit/ Room No., Floor Building Name Lot No., Block No., Phase No. House No. CELL PHONE NUMBER (Required) HOME TELEPHONE NUMBER
0915-9175-115 0303255362
Street Name Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code APPLICANT’S TAXPAYER SSS/GSIS NO.
IDENTIFICATION NUMBER (TIN)
289-114-202-000 01-1565214-9
PERMANENT HOME ADDRESS (Required) Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. BUSINESS TELEPHONE NUMBER NATURE OF WORK
151 GREENVIEW ROAD EMPLOYED
Street Name Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code LOAN TERM DESIRED LOAN AMOUNT
3500  Two (2) Years  Three (3) Years
ZONE 1 ATULAYAN NORTE TUGUEGARAO CITY CAGAYAN
EMPLOYER/BUSINESS NAME LOAN PURPOSE
DIVINE MERCY WELLNESS CENTER Non-Housing Related
 Vacation/travel
 Livelihood/additional capital in small
EMPLOYER/BUSINESS ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name  Special events
business
 Car repair
ARELLANO CORNERE BURGOS  Tuition/Educational Expenses
 Health & wellness
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code  Payment of utility/credit card bills
 Purchase of appliance &
CENTRO 06 TUGUEGARAO CITY CAGAYAN 3500 furniture/electronic gadgets
 Others, specify
Housing Related
EMPLOYEE ID NUMBER DATE OF EMPLOYMENT SOURCE OF FUND ______________
 Minor home improvement/home
865 FEBRUARY 13, 2020 SALARY renovation/ upgrades
PREVIOUS EMPLOYMENT DETAILS FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME EMPLOYER/BUSINESS ADDRESS FROM (mm/yy) TO (mm/yy)

SIGNATURE OF APPLICANT PAYROLL ACCOUNT/DISBURSEMENT CARD

In the event of the approval of my application for Multi-Purpose Loan, I hereby authorize
Pag-IBIG Fund to credit my loan proceeds through my Payroll Account/Disbursement Card that
NAME OF BANK/BRANCH
I have indicated on the right portion.

APPLICATION AGREEMENT
In consideration of the loan that may be granted by virtue of this application subject to the pertinent provisions of the Implementing Rules This office agrees to collect the corresponding monthly
and Regulations of Pag-IBIG Fund, I hereby waive my rights under R.A. No. 1405 (Secrecy of Bank Deposits Act) and authorize amortization on this loan and the MS of herein applicant
Pag-IBIG Fund to verify/validate my payroll account/disbursement card. Furthermore, I hereby authorize my present employer, through salary deduction, together with the employer
____________________________________________________________________ or any employer with whom I may get employed counterpart, and remit said amounts to Pag-IBIG Fund on or
in the future, to deduct the membership savings (MS) and monthly amortization due from my salary and remit the same to Pag-IBIG before the 15th day of each month, for the duration that the loan
Fund. If the resulting monthly net take home pay after deducting the computed monthly amortization on MPL falls below the monthly net remains outstanding. However, should we deduct the monthly
take home pay as required under the GAA/company policy, I authorize Pag-IBIG Fund to compute for a lower loanable amount. amortization due from the applicant’s salary but failed to remit
I understand that should I fail to pay the monthly amortization due, I shall be charged with a penalty of 1/20 of 1% of any unpaid amount it on due date, this office agrees to pay the corresponding
for every day of delay. penalty charged to applicant equivalent to 1/20 of 1% of any
unpaid amount for every day of delay and penalty for non-
If for any reason excess loan proceeds are erroneously credited to my payroll account/disbursement card, I hereby authorize Pag-IBIG
Fund to debit/deduct the excess amount from my account without need of further notice of demand. Should my account balance be remittance equivalent to 1/10 of 1% per day of delay of the
insufficient, the Fund has the right to demand for the excess amount to be refunded. amount payable from the date the loan amortization or
payments fall due until paid.
I authorize Pag-IBIG Fund to disclose, submit, share or exchange any of my account information to legal and government regulating
agencies, other banks, partner-merchants or third party in accordance with R.A. No. 9510 (Credit Information System Act), R.A. No.
10173 (Data Privacy Act of 2012), and other related or pertinent laws and regulations, as described in Pag-IBIG Fund’s Freedom of
Information (FOI) Manual. The credit information may also be transferred to service providers (e.g., Credit Information Corporation, _________________________________________
Bankers Association of the Philippines - Credit Bureau), likewise in accordance with laws and regulations. HEAD OF OFFICE OR AUTHORIZED SIGNATORY
(Signature Over Printed Name)
Furthermore, I have read, understood and agree to be bound by the terms and conditions governing the
eDisbursement Facility/Program and Pag-IBIG Fund’s partner-banks’ internal guidelines.
_________________________________________
I certify that the information given and any or all statements made herein are true and correct to the best of my knowledge and belief. I DESIGNATION
hereby certify under pain of perjury that my signature appearing herein is genuine and authentic.
______________ _______________ ______________
JELANE AMOURELLE A. BARCELLANO
___________________________________ Pag-IBIG AGENCY CODE BRANCH CODE
Signature of Applicant Over Printed Name EMPLOYER ID NO.
PROMISSORY NOTE
For value received, I promise to pay on due date without need of demand to the order of 5. I shall be considered in default in any of the following cases:
Pag-IBIG Fund with principal office at Petron MegaPlaza, 358, Sen. Gil Puyat Avenue., City a. Any willful misrepresentation in any of the documents executed in relation hereto;
of Makati the sum of Pesos: b. Failure to pay any three (3) consecutive monthly amortizations;
c. Failure to pay any three (3) consecutive membership savings;
(P_______________) Philippine Currency, with an interest at the rate of 10.5% per annum d. Violation of any of the membership/STL/housing loan policies, rules, regulations, and
(equivalent rate of 17.50% based on diminishing principal balance), with interest during the guidelines of the Pag-IBIG Fund.
grace period and shall be amortized equally over the term of the loan. 6. In the event of default, the outstanding loan obligation shall become due and shall be
deducted from the Total Accumulated Value (TAV) after exerting all collection efforts.
I hereby waive notice of demand for payment and agree that any legal action, which may However, immediate offsetting of my outstanding loan obligation may be effected
arise in relation to this note, may be instituted in the proper court of Makati City. immediately upon approval of my request, provided such request is based on the
Finally, this note shall likewise be subject to the following terms and conditions: following justifiable reasons and upon validation by the Fund: Total disability or
1. I shall pay the amount of Pesos: _______________________________ insanity; Separation from service by reason of health; Death of member’s
(P_______________) through salary deduction, whenever feasible, over a period of immediate family member; Distressed member due to unemployment limited to
two (2) years or three (3) years, with a grace period of 2 months. In case I am unable layoff and/or closure of company; Critical illness of the member or any of his/her
to pay through salary deductions for any of the following circumstances, such immediate family member, as certified by a licensed physician under one of the
as but not limited to, suspension from work; leave of absence without pay; following categories, subject to the approval of the DCEO-Member Services
insufficiency of take home pay at any time during the term of the loan; or other Cluster: cancer, organ failure, heart-related illness, stroke and neuromuscular-
circumstances analogous to the foregoing, payments should be made directly to related illness; Repatriation of OFW member from host country and other
the Pag-IBIG Fund office where the loan was released. meritorious grounds as may be approved for by the Board, by reason thereof,
th
2. Payments are due on or before the 15 day of the month starting on resulted in his failure to pay the required amortization when due.
_________________________. 7. In the event of membership termination prior to loan maturity, any outstanding loan
3. Payments shall be applied according to the following order of priorities: Penalties, obligation, shall be deducted from my TAV and/or any amount due me or my
Interest and Principal. beneficiaries in the possession of the Fund. In case of my death, the outstanding
4. A penalty of 1/20 of 1% of any unpaid amount shall be charged to me for every day of obligation shall be computed up to the date of death. Any payment received after date
delay. of death shall be refunded to my beneficiaries.
Signed in the presence of: 8. In case of falsification, misrepresentation or any similar acts committed by me,
Pag-IBIG Fund shall automatically suspend my loan privileges indefinitely. I shall abide
with all the applicable rules and regulations governing this lending program that
________________________________ ________________________________ Pag-IBIG Fund may promulgate from time to time.
Witness Witness
(Signature Over Printed Name) (Signature Over Printed Name) JELANE AMOURELLE A. BARCELLANO
__________________________________
Signature of Applicant Over Printed Name
AUTHORITY TO DEDUCT (Optional)
In case of retirement/separation from employment, I hereby authorize my employer to deduct any outstanding MPL balance from my retirement SIGNATURE OF APPLICANT
or separation benefits to fully settle my loan obligation. In the event that my retirement/separation benefits are not sufficient to settle the outstanding
balance of my MPL or my employer fails for whatever reason, to deduct the same from said retirement/separation benefits, I hereby authorize
Pag-IBIG Fund to apply whatever benefits are due me from the Fund to settle the said obligation.
THIS PORTION IS FOR Pag-IBIG FUND USE ONLY
RECEIVED BY: APPROVED/DISAPPROVED BY:

(SIGNATURE OVER PRINTED NAME) _____________ (SIGNATURE OVER PRINTED NAME) _____________
(POSITION/DESIGNATION) DATE (POSITION/DESIGNATION) DATE
THIS FORM CAN BE REPRODUCED. NOT FOR SALE
 HQP-SLF-065
GUIDELINES AND INSTRUCTIONS (V06, 08/2021)

A. Who May File

Any Pag-IBIG Fund member who satisfies the following requirements:
1. Has made at least 24 monthly membership savings (MS);
CERTIFICATE OF NET PAY ▪ A member who has withdrawn his MS due to membership maturity or who has optionally withdrawn his MS, shall
be allowed to apply for an MPL provided said member has subsequently accumulated 24 MS or at least its
equivalent from the cut-off date of membership maturity or optional withdrawal.
▪ A member, who does not meet the required 24 MS, may nevertheless, be allowed to avail of an MPL if his total
savings is at least equivalent to 24 MS at the rate applicable to him.
2. Has made at least one (1) MS within the last six (6) months prior to the date of loan application;
3. If with existing Pag-IBIG housing loan, the account must not be in default as of the date of application;
4. If with existing MPL and/or Calamity Loan, the account/s must not be in default as of date of application; and
5. Has sufficient proof of income.
B. How to File
NAME OF BORROWER The applicant shall:
1. Secure the Multi-Purpose Loan Application Form (MPLAF) from any Pag-IBIG Fund branch or download from
Pag-IBIG website at www.pagibigfund.gov.ph.
For the month of: _________________ 2. Accomplish 1 copy of the application form.
3. For releasing of loan proceeds through Payroll Account/Disbursement Card, attach photocopy of payroll
account/disbursement card/deposit slip (for newly-opened account).
4. Submit accomplished application, together with the required documents to any Pag-IBIG Fund Branch. Processing of
loans shall commence only upon submission of complete documents.
Basic Salary _________________ C. Loan Features
1. Loan Amount
A qualified Pag-IBIG member shall be allowed to borrow an amount based on the lowest of the following:
Add: Allowances 1.1 Desired Loan Amount
1.2 Loan Entitlement
The loan entitlement shall be equivalent to eighty percent (80%) of TAV. However, If the borrower has an existing
_____________________ __________ calamity loan, the loanable amount shall be the difference between the 80% of the borrower’s TAV and the
outstanding balance of his calamity loan.
1.3 Capacity to Pay
The loanable amount shall be limited to an amount which will not render the borrower’s Net Take Home Pay
_____________________ __________ (NTHP) to fall below the minimum requirement as prescribed by the General Appropriation Act (GAA) or company
policy, whichever is applicable.
2. Interest Rate
_____________________ __________ The loan shall be charged with an interest of 10.5% p.a. (equivalent rate of 17.5% based on diminishing principal
balance) with interest during the grace period and shall be amortized equally over the term of the loan.
3. Loan Term
_____________________ __________ The loan shall be repaid over a period of two (2) years or three (3) years, at the option of the member upon
loan application, with a grace period of two (2) months.
However, in the event that the borrower does not indicate the chosen loan term, the default term shall be three
_____________________ __________ (3) years.
4. Loan Release
The loan proceeds shall be released through any of the following modes:
_____________________ __________ a) Crediting to the borrower’s disbursement card or Loyalty Card Plus;
b) Crediting to the borrower’s bank account through LANDBANK’s Payroll Credit Systems Validation (PACSVAL);
c) Check payable to the borrower. However, when the check remains unclaimed for a period of thirty (30) calendar
days from the DV/Check date despite notice to the borrower (either by email, registered mail or personal
delivery to his postal address, or Short Message Service (SMS) informing him that the same is available
for release, the check shall be cancelled and the loan will be reversed.
Gross Monthly Income __________ d) Other acceptable modes of disbursement.
5. Loan Payments
5.1 The loan shall be paid in equal monthly payments in such amounts as may fully cover the principal and interest
over the loan period. Said amortization shall be made, whenever feasible, through salary deduction.
5.2 For self-employed individuals, Overseas Filipino Workers (OFWs), or other types of individual payors, monthly
Less: Deductions payments shall be paid over-the-counter or any other modes of payment approved by the Fund.
5.3 Payments shall be remitted to the Fund on or before the fifteenth (15 th) day of each month, starting on the third
(3rd) month following the date on the DV/check or manual disbursement voucher.
5.4 If the due date falls on a non-working day, the monthly amortization shall be paid on the first working day after the
_____________________ __________ due date.
5.5 The borrower may fully pay the outstanding balance of the loan prior to loan maturity.
5.6 The borrower shall pay directly to the Fund in case the borrower is unable to pay through salary deduction for any
_____________________ __________ of the following circumstances, such as but not limited to:
a. Suspension from work
b. Leave of absence without pay
_____________________ __________ c. Insufficiency of take home pay at any time during the term of the loan; or
d. Other circumstances analogous to the foregoing.
5.7 Payment shall be applied according to the following order of priorities:
a. Penalties; if any
_____________________ __________ b. Interest; and
c. Principal
5.8 Any amount in excess of the required monthly amortization shall be applied to succeeding amortizations which
Issued this _______ day of _________,
____________________ 20__.
__________ will be posted on the next due date.
I certify under pain of perjury that the above- 6. Penalties
A penalty of 1/20 of 1% of any unpaid amount shall be charged to the borrower for every day of delay. For borrowers
mentioned information is true and correct.
_____________________ __________ paying through salary deduction, penalties shall only be reversed only upon presentation of proof that non-payment
was due to the fault of the employer. In such case, penalties due from the borrower shall be charged to the employer.
Non-remittance of the total loan amortization shall likewise subject the employer with a penalty of 1/10 of 1% per day
of delay of the amounts payable from the date the loan amortization or payments fall due until paid.
7. Default
D. ___________________________________________
Loan Renewal The borrower shall be in default in any of the following cases, without need for demand:
HEAD
Total OF OFFICE/AUTHORIZED SIGNATORY
Deductions __________ a. Any willful misrepresentation made by the borrower in any of the documents executed in relation hereto.
E. Loan Renewal (Signature over printed name) b. Failure of the borrower to pay any three (3) consecutive monthly amortizations.
c. Failure of the borrower to pay any three (3) consecutive MS; or
d. Violation by the borrower of any of the membership/STL/housing loan policies, rules, regulations and guidelines of
Pag-IBIG Fund.
8. Effects of Default
Net Monthly Income __________ In the event of default, the outstanding loan obligation shall become due and demandable. The outstanding loan
obligation shall be deducted from the TAV after exerting all collection efforts.
D. Other Provisions
1. The MPL and/or Calamity Loan programs shall be treated as separate and distinct from each other. Hence, the member
shall be allowed to avail of an MPL while he still has an outstanding calamity loan, and vice versa. Application for loans
on these two programs shall be governed by their corresponding guidelines.
2. In no case shall the aggregate STL exceed eighty percent (80%) of the borrower’s TAV.
3. For both 2-year and 3-year terms, a borrower may renew his/her MPL after payment of equivalent to six (6) monthly
amortizations; not earlier than the sixth (6th) monthly amortization due date; and provided that he meets the eligibility
Issued this ________ day of ____, 20___. requirement. The approved loan shall be applied to the borrower’s outstanding MPL obligation and the net proceeds
shall then be released to him. In case of full payment prior to loan maturity, a borrower shall be allowed to apply for a
new loan anytime thereafter.
I certify under pain of perjury that the 4. In the event of membership termination prior to loan maturity, the outstanding loan obligation shall be deducted from
the borrower’s TAV and/or any amount due him or his beneficiaries in the possession of the Fund. In case of the
above-mentioned information is true and borrower’s death, the outstanding loan obligation shall be computed up to the date of death. Any payments received
correct. after death shall be refunded to the borrower’s beneficiaries.
5. Borrower may request for the immediate offsetting of his/her outstanding MPL balance against his/her TAV.
It shall be effected upon approval of the borrower’s request, provided, the request is based on the following
________________________________________ justifiable reasons: Total disability or insanity; Separation from service by reason of health; Death of member’s
immediate family member; Distressed member due to unemployment limited to layoff and/or closure of
HEAD OF OFFICE/AUTHORIZED SIGNATORY company; Critical illness of the member or any of his/her immediate family member, as certified by a licensed
(Signature Over Printed Name) physician under one of the following categories, subject to the approval of the DCEO-Member Services
Cluster: cancer, organ failure, heart-related illness, stroke and neuromuscular-related illness; Repatriation of
OFW member from host country and other meritorious grounds as may be approved for by the Board, by
reason thereof, resulted in his failure to pay the required amortizations when due.
6. If TAV offsetting has been effected on the borrower’s defaulting MPL, he may apply for a new MPL provided he has
paid at least (6) monthly amortizations prior to default and its consequent offsetting against the borrower’s TAV.
However, if he has paid less than 6 monthly amortizations prior to default, he may apply for a new loan only after two
(2) years from the date of TAV offsetting.