SAMPLE ONLY

APPLICATION No. 000000

GENERAL HEADQUARTERS PROVIDENT FUND
LOAN APPLICATION
TANDAAN: RESPONSIBILIDAD PO NG BORROWER ANG PAGFILL-UP NG FORM.
New Loan Renewal of Loan Additional Loan ReLoan
FAMILY NAME FIRST NAME MIDDLE NAME RANK/ BR OF SERVICE: AFP SERIAL NR
WOODSEN RYDER VAN HARRISON 1LT/ PA O-18345
PRESENT UNIT/ UNIT ADDRESS (REQUIRED) SEX STATUS:
GHQ PROVIDENT FUND OFFICE, AFP FINANCE CENTER BUILDING MALE SINGLE WIDOW
CAMP AGUINALDO, QUEZON CITY MARRIED SEPARATED
PERMANENT HOME ADDRESS (REQUIRED) AGE TYPE OF LOAN:
Please indicate complete address 29 EMERGENCY EDUCATIONAL
HOSPITALIZATION HOUSING
BLK 317 LOT 12 MILITARY SUBDIVISION BRGY SECURED, ZIP CODE LENGTH OF SERVICE:
FAIRVIEW, QUEZON CITY 1118 4 YEARS 10 MONTHS
HOME/ OFFICE TEL NR CELLPHONE NR DATE OF BIRTH PLACE OF BIRTH
(02) 888 8171/ 774-6718 0945 317 4374 01 JANUARY 1992 AFPMC, V. LUNA AVE, QUEZON CITY
LANDBANK ACCT NR EMAIL ADDRESS:
0552 1065 63 rydervanwoodsen@gmail.com

RVWoodsen
PAKIKUMPLETO PO ANG MGA HINIHINGING DETALYE. 1LT RYDER VAN H WOODSEN PA
Signature over Printed Name of Borrower

*****************************************************************************************************
MONTHLY AMORTIZATION
AUTHORIZATION FOR PAYROLL/RETIREMENT GRATUITY/COMMUTATION/PENSION DEDUCTION
Pakicheck po ang inyong
To Whom It May Concern: Assessment Slip

I have understood that GHQ Provident Fund is a government fund and accountability. As such, I hereby authorize the
C, AFPFC/COs of Major Services Finance Center to deduct from my monthly salary the amount of EIGHTEEN THOUSAND
ONE HUNDRED SIXTY-SIX AND 67/100 PESOS ONLY (PhP18,166.67) in payment of my loan with the GHQ Provident
Fund Office until such obligation has been fully paid. In the event of separation or retirement from military service/employment
before maturity of my loan, I hereby authorize the C, AFPFC/COs of Major Services Finance Center to deduct fifty percent
(50%) of my retirement benefits/gratuity, commutation of leave, and monthly pension including my 36 months advance pension
until my obligation has been fully satisfied. This authorization shall not be revised or revoked without written conformity of the
GHQ Provident Fund Management.

RVWoodsen
PIRMA AT PANGALAN
Pakipapirmahan po sa
1LT RYDER VAN H WOODSEN PA
Finance Service na Signature over Printed Name of Borrower
nagpapasuweldo sa inyo. Military/Civilian ID# PA00514794
PIRMA AT PANGALAN
Pakipapirmahan po sa Unit
NOTED BY: Commander/Chief of APPROVED BY:
Office/ Admin/Adjutant SaintIversonGDL
LTC CALIX D MARTINEZ (FS) PA BGEN SAINT IVERSON G DE LIANO PAF
CO, 14TH FSFO Commander, GHQ & HSC______
CO/ Chief, FSU/ FSFO Unit Commander / Chief of Office

REPUBLIC OF THE PHILIPPINES

QUEZON CITY S.S

SUBSCRIBED AND SWORN to before me

on this 20TH day of July, 2020 at Quezon City

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 GENERAL HEADQUARTERS PROVIDENT FUND OFFICE
AFP Finance Center, Camp General Emilio Aguinaldo, Quezon City

20 July 2020
The Chairman Date
Thru: The General Manager
GHQ Provident Fund Office
Camp General Emilio Aguinaldo, Quezon City

The undersigned wishes to apply for emergency/ hospitalization/educational/housing loan in the amount of SIX
HUNDRED THOUSAND PESOS (PhP600,000.00).

Truly yours,
PRINCIPAL LOAN
RVWoodsen
Pakicheck po ang inyong
Assessment Slip 1LT RYDER VAN H WOODSEN O-18345 PA__
Rank Name AFPSN
(Signature over Printed Name)
______HPMG, GHQ & HSC, AFP______
PIRMA AT PANGALAN Unit Assignment
Pakipapirmahan po sa
Finance Service na
nagpapasuweldo sa inyo.
AUTHENTICATION

THIS IS TO CERTIFY that the loan applicant a bona fide member of ___HPMG, GHQ & HSC, AFP_ and
PIRMA ATisPANGALAN
qualified to apply for the loan chosen above. Pakipapirmahan po sa inyong (GHQ Unit/ Office)
Unit Commander/Chief of
Office/ Admin/Adjutant
NOTED BY:
SaintIversonGDL
LTC CALIX D MARTINEZ (FS) PA BGEN SAINT IVERSON G DE LIANO PAF
CO, 14TH FSFO Commander, GHQ & HSC___________
CO/ Chief, FSU/ FSFO Unit Commander / Chief of Office
PRINCIPAL LOAN

PROMISSORY NOTE Pakicheck po ang inyong

KNOW ALL MEN BY THESE PRESENTS: Assessment Slip
In consideration for a loan of SIX HUNDRED THOUSAND PESOS ONLY
(PhP600,000.00) receipt of which is hereby acknowledged as indebtedness to the GHQ PROVIDENT FUND OFFICE.
I, 1LT RYDER VAN H WOODSEN PA , of legal age, Filipino Citizen, single/married to
Astrid S. Woodsen, with residence at BLK 317 LOT 12 MILITARY SUBDIVISION BRGY SECURED, FAIRVIEW, QUEZON CITY,
hereby promise to pay the GHQ Provident Fund Office, the amount of SIX HUNDRED THOUSAND PESOS ONLY
(PhP600,000.00) with 3% interest per annum in 36 monthly equal installments effective SEPTEMBER 2020 up to
AUGUST 2023. Ilang buwan babayaran
I hereby pledge and assign
PRINCIPAL LOAN to the GHQ Provident ang Office
Fund loan my salaries/wages and in case of my
retirement/separation fromPakicheck
active military service/employment
po ang inyong
before full payment of this loan, I likewise pledge and assign
fifty percent (50%) of my retirement gratuity,
Assessment Slip commutation of leave, monthly pension and other claims due including my 36
months advance pension to settle the same. For this purpose, I hereby appoint C, AFPFC/COs/Chiefs of Major Services Finance
Centers as my Attorney-in-fact to pay for me the sum of
SIX HUNDRED FIFTY-FOUR THOUSAND PESOS ONLY (PhP654,000.00)
deducting/collecting from any or all of the abovementioned income and claims due me in such amount in full satisfaction of the
principal, interest and other penalties arising from my obligation.
If the equal installments shall have not been collected or paid on due date, said unpaid installment shall earn surcharges
of 1% interest monthly until fully paid. It is my responsibility as borrower: 1) To monitor the status of the account and; 2) To
pay directly to GHQ PROVIDENT FUND OFFICE TOTAL in caseAMOUNT
LOAN Chief, AFPFC
PAYABLE failed to effect billing of my account, payment may
have been deferred, and/or cut-off due to unavoidable circumstances such as but not limited to systems/technical malfunctions
Pakicheck po ang inyong
and other unforeseen events.
Assessment Slip
In case of court action to enforce collection of this loan, I further agree and promise to pay 30% actual and
consequential damages, 10% liquidated damages, 20% Attorney’s fees, of the total obligation due or as may be adjudged by the
court.
I have read and understood the conditions of this loan agreement.

IN WITNESS WHEREOF, We have hereunto set our hands at GHQPFO, Camp Aguinaldo, Quezon City this
20TH day of July 2020.
RVWoodsen
1LT RYDER VAN H WOODSEN O-18345 PA__
Signature over Printed Name of Borrower
______HPMG, GHQ & HSC, AFP______
Unit Assignment
APPROVED/DISAPPROVED by the Credit Committee:
_____________________________ _______________________________
Operations Officer Admin Officer
_________________________
Treasurer
 DEED OF ASSIGNMENT

KNOW ALL MEN BY THESE PRESENTS:

This Deed of Assignment, made and executed by and between

1LT RYDER VAN H WOODSEN PA of legal age, single/married to Astrid S. Woodsen and
a resident of BLK 317 LOT 12 MILITARY SUBDIVISION BRGY SECURED, FAIRVIEW, QUEZON CITY hereinafter
called the ASSIGNOR and the GENERAL HEADQUARTERS PROVIDENT FUND OFFICE (GHQPFO) duly
organized and existing under the laws of the Republic of the Philippines and with
TOTAL official
LOAN AMOUNTbusiness
PAYABLEaddress at the Armed
Forces of the Philippines Finance Center (AFPFC), Camp General Emilio Aguinaldo, Quezon City,
Pakicheck po ang inyong hereinafter called the
ASSIGNEE, withnesseth: Assessment Slip

That the ASSIGNOR is indebted to the ASSIGNEE the in sum of

SIX HUNDRED FIFTY-FOUR THOUSAND PESOS ONLY
(PhP654,000.00)
only and in full payment and complete satisfaction thereof, the ASSIGNOR does hereby ASSIGN, TRANSFER and
CONVEY unto the ASSIGNEE his/her commutation of leave, retirement benefits and monthly pension due from the
TOTAL LOAN AMOUNT PAYABLE
Republic of the Philippines through my pay jurisdiction (AFPFC, FCPA, PAFFC, PNFC), of which above benefits is due
Pakicheck
and payable to the po ang inyong
ASSIGNOR.
Assessment Slip
That the ASSIGNEE does hereby accept this assignment in full payment of the above mentioned debt of
ASSIGNOR in the sum of SIX HUNDRED FIFTY-FOUR THOUSAND PESOS ONLY
(PhP654,000.00) only representing his/her GHQ Provident Fund EMERGENCY_____.
(Type of Loan)

IN WITNESS WHEREOF, the parties have hereunto set their hands this 20TH day of July 2020 at
Quezon City, Philippines.
Uri ng loan na inaaplay
PIRMA AT PANGALAN Emergency/Educational/Housing/
ng BORROWER Hospitalization
ASSIGNEE

RVWoodsen By:
1LT RYDER VAN WOODSEN O-18345 PA _____________________________________
Assignor GENERAL MANAGER - GHQPFO
(Signature over Printed Name)

Signed in the presence of:

BenjaminJimenez
PIRMA AT PANGALAN
BuenaventuraJ
CPT BENJAMIN B JIMENEZ PAF_ Sinumang kakilala o kaopisina CPT JACOB L BUENAVENTURA PA
Witness Witness
(Signature over Printed Name) (Signature over Printed Name)

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES

QUEZON CITY S.S

In the City of Quezon, on the 20th day of July 2020, personally appeared _____________,
known to me to be same person who executed the foregoing Deed of Assignment who acknowledged to me that same is
his/her free act and deed.

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