ARMED FORCES AND POLICE SAVINGS AND LOAN ASSOCIATION, INC.

(Authorized by the Bangko Sentral ng Pilipinas)

EDSA cor. Col. Bonny S. Serrano Road, Camp Aguinaldo, Quezon City Attach
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Branch Office
LOAN APPLICATION

Loan Type Application TypeLoan Purpose. Please choose only one option.
 Salary/ Pension Loan  New  Bills Payment  Travel
 Multi-Purpose Loan  Renewal  Education  Business
 Emergency Loan  Restructured  Medical Expenses  Car Purchase/ Repair
 Others ______________ (specify)  Home Improvement  Others _______________ (specify)
Amount Applied For (In Words) ₧ Requested Term Release of Loan Proceeds
(No. of Months) (choose one)
____________________________________________________________________  Cash
 Credit to SD(02) Account
 AFPSLAI Check
BORROWER’S DATA
Last Name First Name Extension Name (Sr,Jr,III) Middle Name

Rank/ Position AFPSN/ PNP Acct No. Branch of Service Pay Jurisdiction Length of Service Date of Appointment/Retirement (MM/DD/YYYY)

Date of Birth (MM/DD/YYYY) Age Civil Status Mobile Number

 Single  Married  Widow/er  Separated
Complete Office/Business Address/ Unit Assignment Contact Number

Complete Permanent Home Address Contact Number

Complete Provincial Address Contact Number

This loan application is subject to AFPSLAI’s approved policies, terms and conditions.
I hereby certify to the correctness of all information printed/contained herein including all attachments/ annexes hereto.

Signature of Applicant Date of Application

PLEASE DO NOT WRITE BELOW THIS LINE (For AFPSLAI use only)
Member Number Distribution Channel Subject to DST? If collection is thru OTC/Against
 BO  EO _____________________________  Yes  No Deposit, attach OR#/DM slip

Pension Account Number

 CFR _____________________________________________ Subject to CRI? If yes, please tag applicable rate
Market Source  Yes  No in Doc. Monitoring
SD (02) Account Number  Walk-in within AOR  Walk-in outside AOR First-Time Borrower? DOSRI?
 Caravan _________________  Others ______________  Yes  No  Yes  No
EXISTING LOAN DATA
Loan Type/AR Date Granted/Set-up M. A. Term Principal Amount Outstanding Balance As of Loan Status Remarks

RECOMMENDATION AND APPROVAL

Loan Amount Mo. Amortization Loan Term Loan Type Net Pay After Deduction Required NTHP
₧
Effectivity of Mo. Amortization  Next month after the month of release  Two months after month of release including month of release
Comments/ Remarks
Processed by:

___________________________________________
Loan Specialist Signature Over Printed Name
RECOMMEND APPROVAL/ DISAPPROVAL: APPROVED/ DISAPPROVED (For the Board of Trustees):

_______________________________ _____________________________
Signature Over Printed Name Signature Over Printed Name
Application Received by/ Date Encoded by/ Date Membership Data Updated/Proofread by/ Date

LMS-2012-01
 PROMISSORY NOTE No. 0123456789

______________________, 20____

FOR VALUE RECEIVED, I/WE JOINTLY AND SEVERALLY PROMISE TO PAY THE ARMED FORCES AND POLICE
SAVINGS AND LOAN ASSOCIATION, INC (AFPSLAI), WITH MAIN OFFICE LOCATED IN CAMP AGUINALDO, OR ANY OF
ITS BRANCHES, THE SUM OF _________________________________________________PESOS (₧______________),
WITH EFFECTIVE INTEREST OF __________% PER ANNUM PAYABLE FOR ___________ MONTHS AT A MONTHLY
AMORTIZATION OF ₧________________, TO MATURE ON _______________, 20___.

I/We also agree to pay the amount due including additional interest at the rate above stated and charges on all
monthly amortizations that are defaulted or delayed, be it my/our own oversight or not without further need of notice
or demand.

In case I/we default or fail to pay any of the amortizations on the indebtedness or the interest when due, then
the entire principal plus the interest that has so far accrued shall, at the option of AFPSLAI immediately become due
and payable without need of notice of demand and I/we jointly and severally agree to pay any outstanding amount due
on this loan plus interests thereon at the rate of interest stated above on the said amount due, compounded monthly
until fully paid. In which case, I/we hereby authorize and empower AFPSLAI even without prior notice to me/us to
collect/offset any money of whatever kind or nature, securities and things of value which may be in its hands or
otherwise to the credit of or belonging to all or anyone of us. AFPSLAI is hereby authorized to sell at public or private
sale such securities or things of value for the purpose of applying their proceeds as payment of this loan.

I/we also hereby authorize AFPSLAI to amend the amount of amortizations and the number of payments
without prior notice in case of non-payment, understated payment and/or early payment of the loan.

In case of non-payment and this note is referred for collection, I/we jointly and severally agree to pay in
addition to and based on the outstanding amount due and the cost of the suit, attorney’s fees, as well as other
necessary and incidental expenses.

I/we further agree that in case of separation from the service for whatever cause, the unpaid balance, including
its accumulated interest and surcharges as stipulated above, shall be deducted from my/our last payment,
commutation of leaves, furlough, RSBS refund, pension and all other separation benefits and thereby waive my/our
rights under applicable rules.

__________________________________
BORROWER
SIGNATURE OVER PRINTED NAME

LEFT THUMBMARK RIGHT THUMBMARK

AFPSLAI ID No.

____________________________________ __________________________________
CO-MAKER’S SIGNATURE CO-MAKER’S SIGNATURE

AFPSLAI ID No. AFPSLAI ID No.

CO-MAKER’S DATA CO-MAKER’S DATA

Member Number Member Number

Last Name First Name Middle Name Last Name First Name Middle Name

Branch of Service Rank/ Position AFPSN/ PNP Account No. Branch of Service Rank/ Position AFPSN/ PNP Account No.

Pay Jurisdiction Mobile Number Pay Jurisdiction Mobile Number

Complete Office Address/ Unit Assignment Contact Number Complete Office Address/ Unit Assignment Contact Number

Complete Permanent Home Address Contact Number Complete Permanent Home Address Contact Number
 AUTHORIZATION FOR PAYROLL/PENSION DEDUCTION AND REMITTANCE

(The APDR portion applicable to the co-maker(s) will be implemented when the borrower fails to pay).

TO WHOM IT MAY CONCERN:

I/we hereby authorize deduction from my/our payroll/pension and remittance of the amount of
________________________________________________________PESOS (₧____________) every month beginning
______________,20___ for payment of my/ our obligation with the AFPSLAI until the same obligation is fully paid. This
authorization shall not be revised or rescinded without the conformity in writing of AFPSLAI. If not deducted and/or remitted
by my/our Finance Officer on time, I/we shall pay the delinquent accounts and/or penalty thereof. I/We also authorize the
Finance Officer to accelerate my/our payments and to update my/our accounts anytime the obligation is still subsisting.
Further, I/ we shall inform AFPSLAI of any change in my/ our pay jurisdiction.

IN CASE I/WE ARE SEPARATED FROM OUR EMPLOYMENT BEFORE THE MATURITY OF MY/OUR LOAN, I/WE SHALL PAY
THE BALANCE, INTERESTS, FEES AND COSTS TO AFPSLAI. I/WE AUTHORIZE MY/OUR FINANCE OFFICE TO DEDUCT THE
OUTSTANDING BALANCE FROM MY/OUR PENSION/ALLOWANCE/BENEFITS, AND I/WE WAIVE MY/OUR RIGHTS UNDER
REPUBLIC ACT NO. 2310 AND RULE 39 SECTION 13, (L) OF THE RULES OF COURT. IF MY/OUR RETIREMENT PAY COMES
FROM THE GOVERNMENT OR PRIVATE OFFICE, I/WE LIKEWISE AUTHORIZE THE PAYMASTER THEREOF TO DEDUCT AND
REMIT THE ACCOUNTS OUTSTANDING TO THE AFPSLAI.

I/We undertake to personally settle the foregoing obligation to AFPSLAI, with the corresponding interests and charges,
in the event of non-deduction/ non-remittance as stated above.

CO-MAKER BORROWER CO-MAKER

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Rank, AFPSN/PNP Acct No, SVC, Payjur No. Rank, AFPSN/PNP Acct No, SVC, Payjur No. Rank, AFPSN/PNP Acct No, SVC, Payjur No.

I hereby certify that the borrower is a I hereby undertake to deduct the amount
bonafide member of this Unit/Office, that he/she has indicated in the foregoing authorization and remit the
no pending case and is not due for separation from same to AFPSLAI. Any change of stoppage of payment
service in the near future. shall be effected only upon written request from AFPSLAI.

Signature over Printed Name Signature over Printed Name

Commanding Officer/ Chief of Office Disbursing Officer

Payjur Loan Amount Date Granted Mo. Amortization Application Type Loan Type Loan Term

AUTHORIZATION FOR PAYROLL/PENSION DEDUCTION AND REMITTANCE

(The APDR portion applicable to the co-maker(s) will be implemented when the borrower fails to pay).

TO WHOM IT MAY CONCERN:

I/we hereby authorize deduction from my/our payroll/pension and remittance of the amount of
________________________________________________________PESOS ( ₧____________) every month beginning
______________,20___ for payment of my/ our obligation with the AFPSLAI until the same obligation is fully paid. This
authorization shall not be revised or rescinded without the conformity in writing of AFPSLAI. If not deducted and/or remitted
by my/our Finance Officer on time, I/we shall pay the delinquent accounts and/or penalty thereof. I/We also authorize the
Finance Officer to accelerate my/our payments and to update my/our accounts anytime the obligation is still sub sisting.
Further, I/ we shall inform AFPSLAI of any change in my/ our pay jurisdiction.

IN CASE I/WE ARE SEPARATED FROM OUR EMPLOYMENT BEFORE THE MATURITY OF MY/OUR LOAN, I/WE SHALL PAY
THE BALANCE, INTERESTS, FEES AND COSTS TO AFPSLAI. I/WE AUTHORIZE MY/OUR FINANCE OFFICE TO DEDUCT THE
OUTSTANDING BALANCE FROM MY/OUR PENSION/ALLOWANCE/BENEFITS, AND I/WE WAIVE MY/OUR RIGHTS UNDER
REPUBLIC ACT NO. 2310 AND RULE 39 SECTION 13, (L) OF THE RULES OF COURT. IF MY/OUR RETIREMENT PAY COMES
FROM THE GOVERNMENT OR PRIVATE OFFICE, I/WE LIKEWISE AUTHORIZE THE PAYMASTER THEREOF TO DEDUCT AND
REMIT THE ACCOUNTS OUTSTANDING TO THE AFPSLAI.

I/We undertake to personally settle the foregoing obligation to AFPSLAI, with the corresponding interests and charges,
in the event of non-deduction/ non-remittance as stated above.

CO-MAKER BORROWER CO-MAKER

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Rank, AFPSN/PNP Acct No, SVC, Payjur No. Rank, AFPSN/PNP Acct No, SVC, Payjur No. Rank, AFPSN/PNP Acct No, SVC, Payjur No.

I hereby certify that the borrower is a I hereby undertake to deduct the amount
bonafide member of this Unit/Office, that he/she has indicated in the foregoing authorization and remit the
no pending case and is not due for separation from same to AFPSLAI. Any change of stoppage of payment
service in the near future. shall be effected only upon written request from AFPSLAI.

Signature over Printed Name Signature over Printed Name

Commanding Officer/ Chief of Office Disbursing Officer

Payjur Loan Amount Date Granted Mo. Amortization Application Type Loan Type Loan Term