AFPMBAI

ADDITIONAL/E-56/BASIC POLICY LOAN APPLICATION FORM

(02)911-4051 to 58/(02)911-8040 to 44/0920-952-6224

REQUIREMENTS PICK UP HEAD OFFICE DATE FILE/

Policy Contract/Basic Certificate DUE DATE
Latest Payslip MAILING
Statement of Service for 1st loan in Basic Policy PICK-UP REGIONAL OFFICE ________________
NOTE: PLEASE READ INSTRUCTIONS AND FOR DEPOSIT ID CARD NO.
PROCEDURES AT THE BACK. PRINT ALL BANK/BRANCH__________________________
INFORMATION IN CAPITAL LETTERS. ATM/ACCT. NO. _________________________ ____________
_
TYPE OF LOAN:

ADDITIONAL POLICY LOAN E-56 POLICY LOAN BASIC POLICY LOAN

MEMBER’S DATA

_____________________________________________________________________________________ _________________
SURNAME FIRST NAME MIDDLE NAME DATE OF BIRTH
___________________________________ _________________________________ ____________________________
RANK / BR OF SVC / SERIAL NO. FORMER PC INDICATE SERIAL NO. CELLPHONE/CONTACT NO.
_________________________________________________________________________________________________________
COMPLETE ADDRESS
AI_________________________________
E-56 _______________________________ ________________
SIGNATURE OF MEMBER OR RIGHT SIGNATURE OVER PRINTED NAME OF RELATION TO
THUMBMARK (IF CLAIMANT CANNOT SIGN) AUTHORIZED REPRESENTATIVE MEMBER

******************************* FOR FILL OUT BY DIVISIONS CONCERNED *****************************

1. RECORDS 4. CLAIMS DIVISION
(West Wing) (Counters 6 to 11)
Similar Outstanding Accounts:
Different a. Opt. Ins. _____________________
b. Opt. Pol. Loan _____________________
No Record on File
c. Basic Pol. Loan _____________________
Verified by: ___________ d. E-56 _____________________
Noted by: _____________ e. E-56 Pol Loan _____________________
f. Salary Loan _____________________
2. UPSD g. Appliance Loan _____________________
(1st Floor, LIG)
h. Calamity Loan _____________________
Policy/Basic Cert no. ________________________ i. MEDAL _____________________
Face Amount________________Prem.__________ j. REHL _____________________
Effective Date:____________Age:_____Plan_____ k. REML _____________________
Noted by: ______________________ l. Acted as Co-Maker to:_________________
Salary Loan __________________________
3. FINGER SCANNING MEDAL __________________________
(Ground Floor Lobby) Calamity Loan __________________________
Appliance Loan __________________________
With Finger Scan
m. Member’s Status_____________________
No Finger Scan
Verified by: _________________________
Verified by: ______________
Date: ___________________ Noted by: ___________________________

=============================================================================================
AUTHORIZATION TO DEDUCT

TO: CO, FINANCE CENTER POLICY/BASIC CERT. NO. ______________________

Sir: Date Filed: _____________________

For and in consideration of a Policy Loan granted to me by the AFP MUTUAL BENEFIT ASSOCIATION, INC. in the
amount of P_______________I hereby authorize you to deduct from my salary/pension the amount of P _______________ for
the period of _____________ months.
I agree that no other request on my part shall exempt me from the responsibility to seeing to it that the corresponding
deductions are promptly and religiously effected and remitted to the AFPMBAI as they become due.

SIGNATURE:________________________________________ RANK/SN/BR OF SVC: ______________________

NAME: ________________________________________________________________________________________
(PLEASE PRINT LEGIBLY) FIRST NAME MI LAST NAME
UNIT ADDRESS: _______________________________________________________________________________

NAME PER PAYSLIP ________________________________________________________

PLEASE SEE BACK PAGE

ID CARD NO.

POLICY LOAN AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:
In consideration of the loan of ______________________________________ (P_____________) received from the
AFPMBAI, said amount of P__________________ payable in monthly installment of P__________ including interest thereon at 6%
per annum for a period of _____ months:
1. As security of this loan, I hereby assign all my rights and interest under insurance Policy/Basic Certificate No.
___________________.
2. In case the installments and interest thereon are not paid when due, the unpaid installments shall earn an interest at an
additional rate of 6%.
3. All indebtedness under this loan agreement shall become due and payable in case of:
a. Death of the insured;
b. Surrender of the policy for its cash value or reduced paid-up insurance subject to the provisions of paragraph
thereof;
c. Maturity of the policy; or
d. Termination of the policy for any reason in which the total amount of loan plus interest shall be deducted from
the insured beneficiaries or assigned under the policy.
4. In case of loan renewal, payments for my old loan that have not been considered in my loan renewal shall be
automatically credited to my new account/loan.
5. During the payment period, I hereby waive my rights to the cash surrender value of said policy or convert it to paid-up
insurance.
Quezon City _________,20_____.
With My Consent:
______________________________________ ____________________________________________
Beneficiary Signature of Insured/Payor

PROCEDURE IN FILING OF LOAN

1. Get Loan Application Form & priority number; Fill-up Form(all tick-marked
items.)
2. Proceed to Finger Scanning.
3. If loan will be picked-up by a representative, please proceed to Records (West
Building).
4. Proceed to the lobby & wait for your priority number to appear in the queuing
board (Counters 6 to 11 will assist you).
IMPORTANT REMINDERS

A. If a representative will claim the loan proceeds, please present the following to the teller; Special
Power of Attorney (SPA) / Authorization letter and valid IDs of representative and owner of check.

B. Unclaimed check of more than a month will be mailed to the address written in the loan application.

5.