HDMF-EPP INC. Application No.

: _______________
01/2014 Date of Filing: _________________

HDMF EMPLOYEE PROVIDENT PLAN INC.

11thFloor, JELP Business Solutions Bldg.
409 Shaw Boulevard, Mandaluyong City

APPLICATION FOR MODIFIED GENERAL PURPOSE LOAN

UNDER RES. NO. 21, SERIES OF 2014
Important: Please read instructions, terms and conditions at the back

BORROWER (Please Print)

PRESENT POSITION/DESIGNATION: __________________________
DEP’T./BRANCH/REGION: ___________________________________
No. of Years as EPP member: _____________________
LASTNAME FIRST NAME MIDDLE NAME
Contact Nos.
Date of Birth ____________________ Avaya ___________ Land Line: ____________ Mobile: _____________

Complete Home Address ____________________________ Gender: Civil Status:

Male Single
________________________________________________
Female Married Others:_________

Type of Loan Amount Applied for: Terms of Payment

Initial Maximum 5 years 15 years

Renewal Others, Pls. Specify:____________________ 10 years 20 years
(Desired Net Loan Proceeds)
 PROMISSORY NOTE

In consideration of the loan applied for, I promise to pay the amount to the HDMF-Employee Provident Plan under the terms and
conditions printed at the back hereof which I have read and understood clearly, and to which I bind myself to pay the correct monthly
amortization hereon thru payroll deduction, for which I hereby authorize the Disbursing/Collecting Officer to deduct from my salary.
I understand that the loan balances of my Emergency Loan I and Educational Loan shall be deducted from the proceeds of my
Modified General Purpose Loan as provided under HDMF-EPP Circular No.___, Series of 2014.

____________ ______________________________
Date Signature over printed name

I hereby declare, under the penalties of perjury, (Please check appropriate box)
That I have no pending administrative and/or criminal case charged against me.
That I have pending administrative and/or criminal case charged against me and in case of separation from the service due to
retirement, resignation, disciplinary measure, abolition of plantilla position, reorganization or permanent and total disability, all
my outstanding loans shall automatically be deducted from my provident benefits. Should my savings not suffice, I authorize
HDMF-EPP to collect from whatever receivables I have remaining with the HDMF for the full settlement of any unpaid EPP loan
balances.
I further declare to concede to the revocation of this loan and undertake to refund the whole loan proceeds in the event of a
subsequent discovery of misrepresentation or concealment of facts.

____________ ______________________________
Date Signature over printed name

I am fully aware that the maximum 32% tax shall be imposed on the total amount of employers’ counterpart of my Total Accumulated
Value (TAV) in case my separation from HDMF is due to resignation or early retirement below 15 years in service.

I am therefore authorizing the HDMF-EPP to adjust my loanable amount on every renewal date in order to provide for the said tax.

I also agree to maintain in my EPP account a balance of at least twenty percent (20%) of my TAV 1 (EE & ER contribution excluding
earnings) net of provision for income tax (if any) at any given time before my retirement.

____________ ______________________________
Date Signature over printed name

INSTRUCTIONS:

1. Submit only one (1) application form, properly & completely accomplished.

2. Submit original copy or certified true copy of latest payslip duly certified by the payroll officer of the branch/regional
office.

WARNING: Collusion, falsification, misrepresentation of facts or any other kind of anomaly in the accomplishment of
this form, or in obtaining any benefit under this application shall be subject to administrative and/or criminal action.

TERMS AND CONDITIONS

I. Who is qualified - A member who has remitted contributions for at least twelve (12) months; is in good
standing; is not suspended due to administrative or criminal case charged against him.

II. Amount of Loan - A member shall be allowed to borrow as much as 90% of TAV 1 (Total EE & ER
contributions), net of Tax on his INITIAL MGPL availment for the purpose of
consolidating all his other outstanding loans. Succeeding loan renewal, loan amount
shall be equivalent to eighty percent (80%) of TAV 1.

III. Interest Rate - 3.5% per annum.

IV. Repayment Period -Maximum of twenty (20) years, at the option of the Member.

V. Mode of payment - Equal monthly payments thru salary deduction.

VI. Fees - 1.5% of loan amount or P1,000.00 whichever deducted
is higher service fee which is non-refundable in advance
0.2% loan guarantee fee

VII. Penalty - 1% per month on unpaid monthly amortization.

VIII. Default - A member shall be considered in default in any of the following cases:
a. Any willful misrepresentation made by the Member in any of the documents
submitted to the EPP in relation to the loan.
b. Failure to pay three (3) consecutive monthly amortizations.
c. Violation of any of the policies, rules, regulations and guidelines of the HDMF-EPP.

IX. Renewal - Application for loan renewal shall be allowed after paying at least three (3) monthly
amortizations with the corresponding loanable amount based on TAV 1, as shown on the
table of computation below;
RENEWAL NO. OF MONTHS % OF TAV1
INITIAL - 90.00
1st 3 months 89.17
2nd 6 months 88.33
3rd 9 months 87.50 ONE (1) YEAR
4th 12 months 86.67
5th 15 months 85.83
6th 18 months 85.00
7th 21 months 84.17 TWO (2) YEARS
8th 24 months 84.33
9th 27 months 82.50
10th 30 months 81.67
11th 33 months 80.83 THREE (3) YEARS
12th 36 months 80.00

X. Litigation Expenses - In the event the obligation is not paid in accordance with the terms and conditions of
this agreement and the EPP institutes court action to enforce collection, the borrower
shall pay litigation expenses equivalent to at least 20% of the due, and attorney’s fees
equal to 10% of the amount due.

XI. Other conditions a. In the event of death, any outstanding loan and accrued interests – and penalties
thereon shall be paid from the Group Credit Life Insurance or Loan Guarantee Fund,
whichever is applicable.
b. Any event that causes membership termination, all outstanding loan balance
together with accrued penalties and interests shall be deducted from the Member’s
Savings and any other benefits due to the member. The Member shall pay in full any
remaining balance.