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GSIS Loan Application Form | PDF | Loans | Government
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GSIS Loan Application Form

This document is an application for a GSIS (Government Service Insurance System) loan submitted by a teacher. It includes the applicant's personal details such as name, address, employment information, and contact details. The applicant certifies that they are actively employed, have no administrative or legal issues, and provided accurate financial information including income, deductions and net pay. The applicant agrees for loan payments to be deducted from their monthly salary and for GSIS clearance before documents or payments if they separate from service. The application requires signature of the applicant and school head to attest to the details provided.

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Leahcim Awa
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227 views1 page

GSIS Loan Application Form

This document is an application for a GSIS (Government Service Insurance System) loan submitted by a teacher. It includes the applicant's personal details such as name, address, employment information, and contact details. The applicant certifies that they are actively employed, have no administrative or legal issues, and provided accurate financial information including income, deductions and net pay. The applicant agrees for loan payments to be deducted from their monthly salary and for GSIS clearance before documents or payments if they separate from service. The application requires signature of the applicant and school head to attest to the details provided.

Uploaded by

Leahcim Awa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region V
DIVISION OF CAMARINES SUR
Freedom Sports Complex, San Jose, Pili, Camarines Sur

APPLICATION FOR GSIS LOAN

Type of Loan Applied:_________________________

NAME OF APPLICANT:

Last Name First Name Middle Name


Birth Date:_____________________________________________ Age:_____________________________________
Residential Address:__________________________________________________________________________
School Assignment:____________________________________________________________________________
Division/Station/Employee Number :_____________________________________________________________
UMID Card No. (The twelve digits number in your UMID card)____________________________________________
Have you Applied for GSIS loan previously?_____________________________________________________________
If yes type of loan applied:______________________ Date of Application:_______________________________________
Date of Original Appointment:_______________________________________________________________________
Status of Employment:_________________________ E-mail Address:______________________________________
Cell Phone Number:___________________________ Office/Home Phone Number:___________________________
I hereby certify under oath that:
(1) I am in the active service;
(2) I have no pending administrative case and/or criminal charge;
(3) The information supplied by the undersigned is true and correct;
(4) I am not on leave of absence without pay;
(5) That as of the month of __________ 2012, the following appears in my Pay Slip:
Gross Monthly Income: _________________________
Total Deductions: ______________________________
Net Take Home Pay: ____________________________
(6) The monthly amortization shall be deducted from my monthly salary;
(7) In case of separation from the service of the borrower, clearance shall first be
obtained from the GSIS before any document and/or final payment is released in
my favor.

(Signature over Printed Name of borrower)


Date Signed:__________________________________

Attested:

(Signature over Printed Name of the School Head)


Date Signed:__________________________________
Mobile Phone Number:_________________________

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