Republic of the Philippines

SOCIAL SECURITY SYSTEM

MEMBER LOAN APPLICATION

(03-2012) Please read the terms & conditions, instructions at the back of the form, and the attached sheet on Documentary Requirements for Member 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 LOAN TYPE Salary Calamity DATE OF BIRTH (MMDDYYYY) Emergency GENDER Male TELEPHONE/MOBILE NUMBER PREFERRED MODE OF PAYMENT Check Cash Card BANK ADDRESS ATM/Passbook
(NO. & STREET) (BARANGAY) (TOWN/DISTRICT) (CITY/PROVINCE)

NAME

(SURNAME)

(GIVEN NAME)

(MIDDLE NAME)

ADDRESS

(NO. & STREET)

(BARANGAY)

(TOWN/DISTRICT)

(CITY/PROVINCE)

POSTAL CODE

CIVIL STATUS Female E-MAIL ADDRESS

(IF ANY)

Single

Married

Others ________________________________ TIN BANK REFERENCE NUMBER

POSTAL CODE

NAME OF BANK/BRANCH

MEMBER's CERTIFICATION

I certify that the information provided in this form regarding member details 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

DATE

RIGHT THUMB

RIGHT INDEX

If member cannot sign, below are the witnesses to fingerprinting:

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 EMPLOYER'S CERTIFICATION

TIN

I certify that the information provided in this form regarding employer details are true and correct.

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 RECEIVED BY Two valid IDs, one with photo and signature Other documents ______________________________________ 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

TERMS AND CONDITIONS A. ELIGIBILITY REQUIREMENTS 1. Only currently employed, currently contributing self-employed or voluntary member is qualified to avail of the salary loan program: 1.1 For a one-month loan, the member-borrower must have 36 posted monthly contributions, six (6) of which should be within the last 12 months prior to the month of filing of application. 1.2 For a two-month loan, the member-borrower must have 72 posted monthly contributions, six (6) of which should be within the last 12 months prior to the month of filing of application. 2. 3. If the member-borrower is employed, his employer must be updated in contributions and loan remittances. The member-borrower must be updated in the payment of his obligations in his member loans, which include salary, calamity, emergency, educational, stock investment, Member Assistance for the Development of Entrepreneurship (MADE) and housing loans granted under the Unified Housing Loan Program (UHLP) or direct from SSS. The member-borrower has not been granted final benefit, i.e., total permanent disability, retirement and death. The member-borrower must be under sixty-five (65) years of age at the time of application (SSC Res. No. 434 dated 09 November 2005). The member-borrower has not been disqualified due to fraud committed against the SSS.

4. 5. 6. 1. 2.

B. LOAN AMOUNT A one-month salary loan is equivalent to the average of the members latest 12 monthly salary credits posted. A two-month salary loan is equivalent to twice the average of the members latest 12 monthly salary credits posted (rounded to the next higher monthly salary credit), but not to exceed P24,000. 3. For Salary Loan Early Renewal Program (SLERP), the net amount of the loan shall be the difference between the approved loan amount and the previous loan balance. C. REPAYMENT TERM The one-month or two-month salary loan shall be payable within two (2) years in 24 equal monthly installments. However, any principal balance after the maturity date of the loan shall continue to accrue interest until fully paid. D. INTEREST AND PENALTY 1. The loan shall be charged an interest rate of 10% per annum until fully paid, based on diminishing principal balance, and shall be amortized over a period of 24 months. 2. Any excess in the amortization payment shall be applied to the outstanding principal balance. 3. Loan amortization not remitted on due date shall bear a penalty of 1% per month. E. SERVICE FEE A service fee of 1% of the loan amount shall be charged and deducted from the proceeds of the loan. For SLERP, service fee shall be waived. F. LOAN RENEWAL 1. The loan may be renewed after the prescribed amortization period of two (2) years. Balance of P500 or less shall be deducted from the proceeds of the new loan. 2. For SLERP, the sanctions for loan renewal under the condonation program shall be lifted. G. SCHEDULE OF PAYMENT 1. The first amortization shall be paid on the 3rd month following the date of loan, on or before the payment deadline for loans per Circular no. 2011-052. 2. All subsequent remittances shall be made on or before the payment deadlines for loans following the applicable month, at any SSS branch with tellering facility, SSS accredited banks and SSS authorized payment centers. H. RESPONSIBILITY OF MEMBER-BORROWER A member-borrower who transfers employment is obliged to report to the new employer his obligations with SSS and shall allow the new employer to deduct from his salary the corresponding amortization due, plus any penalty for late remittance of amortization. I. RESPONSIBILITIES OF EMPLOYER 1. 2. 3. 4. The employer shall be responsible for the collection and remittance to the SSS of the amortization(s) due on the member-borrowers salary loan through payroll deduction. The employer shall require a new employee to secure from the SSS an updated statement of his account. The employer shall continue the deduction of loan payment for new employees and shall be accountable for its remittance to the SSS. 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, in case the member-borrower is separated voluntarily, (e.g. retirement or resignation) or involuntarily, (e.g. termination of employment or cessation of operations of the company). The employer shall report to the SSS the effective date of separation from the company and the unpaid loan balance of the employee, through the collection list, if the benefit(s) due the employee is insufficient to fully repay his loan.

5. J.

DEDUCTION OF UNPAID LOAN FROM BENEFITS In case of member-borrowers death, total disability, retirement under the Social Security Act, the entire amount or any unpaid amount of the loan, as well as the interest and penalty thereon, if any, shall be deducted from the corresponding benefit.

K. OTHER CONDITIONS 1. 2. Any overpayment on a previous loan shall be applied to the subsequent loan. The borrower shall notify the SSS in case of change of address/employer thru mail/e-mail/over-the-counter (OTC). The notice should indicate the name and SS number of the borrower, addressed to the Member Services Section of the nearest SSS branch, and duly signed by the borrower (in case of mail/OTC). INSTRUCTIONS 1) Member to fill out Member Details. 2) Employer to fill out Employer Details. 3) M Member b must t fil file the th salary l l loan application li ti personally ll and d must t present t hi his S Social i lS Security it card. d In the absence of the Social Security card, please refer to the attached sheet on Documentary Requirements for Member Loan Application. 4) If filed by representative of member or employer, the authorized representative must present the documentary requirements per attached sheet on Documentary Requirements for Member Loan Application.
as of 8/14/12

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.A. 1161, AS AMENDED) OR APPLICATION FOR LOAN WITH THE SSS SHALL BE LIABLE CRIMINALLY UNDER SECTION 28 OF R.A. 8282 OR UNDER PERTINENT PROVISION OF THE REVISED PENAL CODE OF THE PHILIPPINES.