Revised form January 2023

BUREAU OF JAIL MANAGEMENT AND PENOLOGY

SAVINGS AND LOAN ASSOCIATION, INC.
(Authorized by the Bangko Sentral ng Pilipinas)
G/F BJMP Bldg., BJMP NHQ Compound, 144 Mindanao Avenue,
Brgy. Bahay Toro, Project 8, 1106 Quezon City, Metro Manila
Tel. Nos. 09178587163/ 09420259732 / BJMPSLAI FB Messenger

LOAN APPLICATION

ATTACHMENT: 1. Copy of BJMP pay slip and ID 2. Front of LBP ATM (SA#)
Loan Purpose Loan Term (number of months to pay). Please choose:
Appliance/Furniture/Equipment Travel and tour 12 24 36 48 60
Medical Car Purchase/Repair Amount applied for in words (P )
Home Improvements Business __________
Education/Tuition Fee Others ____________ (PESOS)
Release of loan proceeds: choose one Check LBP ATM LBP SAVINGS ACCOUNT NO.

BORROWER’S DATA
Last Name First Name Extension Name (Sr, Jr, II) Middle Name

Date of Birth (mm-dd-yy) Age Place of Birth Gender: E-mail Address: FB Messenger:

Civil Status Single Married Widower Separated Contact No. REMARKS (FOR BJMPSLAI USE ONLY)

Complete Office Address/Unit Assignment

Complete Permanent Home Address

Complete Provincial Address

BJMPSLAI upholds an individual's data privacy rights and observes that all personal information, sensitive personal information and
privileged information collected and to be collected are processed or recorded, managed, organized, stored, updated, retrieved,
consolidated, used, blocked, and erased according to the Data Privacy Act of 2012 (Republic Act 10173), its Implementing Rules and
Regulations (IRR),and various Circulars under the principles of transparency, legitimate purpose, and proportionality.

I hereby give my consent to the processing, sharing, and/or transferring of my personal data relating to my account/s, without notice,
to BJMPSLAI, its service providers and entities or third parties having authority or right to such disclosure of information as in the case
of regulatory agencies, governmental or otherwise, which have required such disclosure from BJMPSLAI, also to enable BJMPSLAI to
service my account/s, to process my requests and transactions with it, to provide all existing features and future enhancements thereto,
and to avail other BJMPSLAI products, services, and facilities, as the BJMPSLAI deems necessary. I agree to hold BJMPSLAI, and
third-party service providers free and harmless from any liability arising from or in connection with the consent herein
given.

______________________________________ ________________
Signature over printed name of the borrower Date

PLEASE DO NOT WRITE BELOW THIS LINE (For BJMPSLAI use only)
CERTIFICATIONS
I hereby certify that the applicant is I hereby certify that the applicant is: I hereby certify that the applicant: I hereby undertake to deduct and
not due for separation not subject to initial investigation has no pending administrative collect from the BJMP payroll the
in the near future subject to initial investigation case amount of monthly amortization on
due for separation in the has pending administrative case this loan and remit the same to the
near future BJMPSLAI and abide with other
related stipulations as provided in
the MOA between BJMP and
BJMPSLAI

____________________________ ____________________________ ____________________________ ____________________________

DPRM DIP LEGAL CHIEF, FINANCE SERVICE

RECOMMENDATION AND APPROVAL

Maximum Loanable Amount Recommended Principal Amount Mo. Amortization Term Start of Mo. Amortization Net Pay after Deduction

Processed by: Reviewed by:

Loan Processor’s Signature Over Printed Name Loans Head’s Signature Over Printed Name
Approved by the BOT Authorized Representative:

VP and General Manager

 Revised form January 2023

PROMISSORY NOTE
_______________________
Date

FOR VALUE RECEIVED, I PROMISE TO PAY THE BUREAU OF JAIL MANAGEMENT AND PENOLOGY SAVINGS AND LOAN ASSOC., INC
(BJMPSLAI), WITH OFFICE LOCATED AT144 MINDANAO AVENUE, BARANGAY BAHAY TORO, PROJECT 8, QUEZON CITY, THE SUM
OF__________________________________________PESOS (P _________________) PHILIPPINE CURRENCY, WITH INTEREST OF
____________percent (_____%) PER ANNUM PAYABLE FOR ______ MONTHS AT A MONTHLY AMORTIZATION OF P_________________,
TO MATURE ON ______________________, 20______.

I 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 intentional or not without further need of notice or demand.

I hereby authorize BJMPSLAI to amend the amount of my amortization and the number of payments without prior notice in case of non-payment,
short payment and/or early payment of the loan. In case I defaulted or failed to pay any of the amortizations on the indebtedness or the interest
when due, the entire principal plus the interest that has so far accrued shall immediately become due and payable without need of notice of
demand and I agree to pay any outstanding amount due, compounded monthly until fully paid. In which case, I hereby authorize and empower
BJMPSLAI even without prior notice, to collect any money, securities or things of value which may be in its hands or otherwise to the credit of or
belonging to me for the purpose of applying their proceeds as payment of this loan.

In case of no payment and this note is referred to a lawyer/collection agency for collection, I 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.

If after one (1) month no deduction has been effected on my pay slip, I will call/inform BJMPSLAI office. I will personally pay the amortization/s
not deducted from my pay slip. In any case, however, surcharge for non-payment will be imposed.

I 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 last payment, commutation of leaves, furlough, pension and all other separatio n benefits and
thereby waive my rights under applicable rules.

AUTHORIZATION FOR PAYROLL/PENSION DEDUCTION AND REMITTANCE

TO WHOM IT MAY CONCERN:

I hereby authorize the deduction from my payroll/pension and remittance of the amount P_________________ every month beginning
______________________, 20_____ for payment of my obligation with BJMPSLAI until the same obligation will be fully paid. This authorization
shall not be rescinded without the conformity in writing of the BJMPSLAI. If the amount is not deducted and/or remitted by the Finance Officer, I
shall pay the delinquent accounts anytime the obligation is still subsisting.

IN CASE I AM SEPARATED FROM MY PRESENT EMPLOYMENT BEFORE THE FULL PAYMENT OF MY LOAN, I SHALL PAY THE
BALANCE, INTEREST, FEES, AND COSTS TO THE BJMPSLAI. I ALSO VOLUNTARILY AUTHORIZE, THROUGH A SPECIAL POWER OF
ATTORNEY (SPA), THE BJMP FINANCE OFFICER TO DEDUCT ANY OUTSTANDING LOAN BALANCE FROM MY PENSION
ALLOWANCE/BENEFITS, SEPARATION PAY, GRATUITY PAY, AND OTHER RETIREMENT BENEFITS, AND SUCH OTHER BENEFITS,
SUBJECT TO APPLICABLE LAWS, RULES, AND REGULATIONS, AND REMIT THE ACCOUNTS OUTSTANDING WITH THE BJMPSLAI,
AND THEREBY WAIVED MY RIGHTS UNDER RA 2310 AND RULE 39, AND OTHER PERTINENT LAWS, AND THE RULES OF COURT. IN
THE EVENT THAT THE AFOREMENTIONED BENEFITS ARE NOT SUFFICIENT TO SETTLE THE OUTSTANDING LOAN BALANCE OR THE
BJMP FINANCE OFFICE FAILS FOR WHATEVER REASON TO DEDUCT THE SAME FROM MY SALARY/SEPARATION/RETIREMENT
BENEFITS, I HEREBY AUTHORIZE THE BJMPSLAI TO APPLY WHATEVER BENEFITS ARE DUE TO ME (e.g. CAPITAL CONTRIBUTION,
SAVINGS DEPOSITS), TO SETTLE SAID OBLIGATION.

CERTIFICATION
KNOW BY ALL MEN BY THESE PRESENTS

That the loan is covered by Credit Group Life Insurance (CGLI) by virtue of his/her compliance of the provision of this MRI for his/her loan granted
on _______________ in the amount of PESOS (P________________) and in the event the insurance pays the unpaid loan or a portion thereof,
I ___________________________________________ obligate myself to pay the outstanding balance to the BJMPSLAI. I HEREBY AUTHORIZE
THE Chief, BJMP Finance Service Office to pay BJMPSLAI any amount due from the BJMP on account of my separation from the service to the
extent of the amount of the unpaid loan or a portion thereof.

_________________________________________ _________________
Signature over printed name of the borrower Date

TERMS AND CONDITION

1. Maximum amount of total loan – shall not exceed twelve (12) times of the borrower’s total earnings or retirement pension from employment as shown on the latest pay slip,
plus annual regular bonuses/incentives and plus amount deposited or contributed by the member-borrower.
2. Due date of the first monthly installment – shall be on the first day of the following month after granting the loan and every month thereafter until the loan is fully paid.
3. Interest rate – shall be computed using the diminishing balance method.
4. Maturity of the loan – shall automatically matures upon the death of the borrower notwithstanding that a longer term was chosen by the borrower. Upon the maturity of the
loan, the entire principal amount on this loan including all interest and other charges, shall be due and payable without the need of demand or further notice, all of which are
hereby expressly waived by the borrower.
5. Authority to apply payment – in case of maturity of this loan due to death of the borrower and it remains outstanding either in whole or in part, both for principal and interest,
the BJMPSLAI is authorized to apply survivor’s benefit due to his/her beneficiaries, the amount equivalent to the outstanding balance of this loan, inclusive of interest,
penalties and surcharges. Further, in the event that the survivor’s benefit is insufficient to fully settle the outstanding obligation, BJMPSLAI is authorized to apply the monthly
survivorship pension (basic survivorship pension and dependent’s pension) due to the qualified survivorship/s to the remaining outstanding obligations until the loan is fully
paid. Such authorization shall remain effective until full payment of the loan or any other outstanding obligations of the borrower to the BJMPSLAI, by virtue of this loan
and/or other obligation constitute a lien over any benefits/claims that may be due the borrower.
6. Pre-termination penalty (5%) – In the event that the borrower decide to pre-terminate his/her contracted loan, he will be charged with a pre-termination fee of 5% of the
outstanding principal and any interest due.

Subscribed and sworn to before me this _________ day of ______________20___.

NOTARY PUBLIC
Doc No.__________:
Page No._________:
Book No._________:
Series of_________:
 Revised form January 2023

SPECIAL POWER OF ATTORNEY

REPUBLIC OF THE PHILIPPINES)

Quezon City ) SS

KNOW ALL MEN BY THESE PRESENTS:

I, _______________________________________________, of legal age, married/single, a resident

of__________________________________________________________________, do hereby name, constitute and appoint
the Chief, Bureau of Jail Management and Penology (or BJMP) Finance Service Office, or his duly authorized
representative, with office address at 144 BJMP Bldg., Mindanao Avenue, Quezon City, as my true and lawful
Attorney-in-fact to act for and in my name and represent me, in case I am separated from my employment before
the maturity of my loan from the BUREAU OF JAIL MANAGEMENT AND PENOLOGY Savings and Loan Association, Inc.,
to process the deduction of my outstanding balance from the benefits that I am entitled to receive, and whatever
funds and benefits due in my favor - such as, but not limited to my retirement pay/gratuity pay, pension, and other
benefits from the government or private institutions - and remit the accounts outstanding with the BJMP Savings and
Loan Association, Inc.

I hereby grant my representative irrevocable full power and authority to execute and perform
every act necessary to render effective the power as though I myself have so performed it and
hereby approving all that he/she may do by virtue of these presents.

In witness whereof, I hereunto set my hand this ____ day of _____________, 20___ at Quezon City,
Philippines.

____________________________
Signature over Printed Name
of Principal/Borrower

WITNESSES:

____________________________ ____________________________
Signature over Printed Name Signature over Printed Name

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public, for and in the above jurisdiction, personally appeared on
_______ of _______________, 20__, the following persons:

Name Identification Date and Place of Issuance

_________________________ ____________ ___________________________
_________________________ ____________ ___________________________

known to me to be the same persons who executed the foregoing instrument and they
acknowledged to me that the same is their own free and voluntary act and deed.

WITNESS my hand and seal on date and at the place written above.