Form No.

EduA-2012-05-001

EDUCATIONAL ASSISTANCE APPLICATION FORM

THISAPPLICATIONSHALLNOTBEPROCESSEDUNLESSCOMPLETELYFILLEDOUT.
BP No. Name of Applicant Last Name Sex : Male Cellphone No Residential Address Office Address Name of Spouse (if Married) Last Name First Name Middle Name Female Civ il Status Single First Name Married Middle Name Widow /Widow er Separated Landline No. (if av ailable) Zip Code Zip Code Date of Birth of Spouse M M D D Y Y Y Y CRN (if UMID cardholder): Old ID No. (if eCard Plus cardholder) Date of Birth of Applicant M M D Religion D Y Y Y Y

E-Mail Address (if av ailable)

I agree to pay the interest due in sixty (60) monthly amortizations and the principal amount at the last month of the term, and that this assistance shall at all times be subject to the terms and conditions mentioned in this application.

TERMS AND CONDITIONS 1. Eligibility: All active members, regardless of salary, length of service, and status of agency and member accounts (i.e. up-to-date, in arrears or suspended) are entitled to avail of the educational assistance. 2. Assistance Amount: Four Thousand Pesos (Php 4,000.00) 3. No Deduction on the Assistance Amount: No service fee and redemption insurance premium shall be deducted from the assistance amount of P4,000.00. 4. Availment: One-time availment of the assistance shall be from May 2012 until December 28, 2012. 5. Mode of Application: Application shall be made over-the-counter (OTC), to be filed either by the member or through the Liaison Officer (LO). 6. AAO Certification: Approval of the educational assistance application shall not require certification from the Agency Authorized Officer (AAO) nor endorsement from the agency. 7. Term and Interest Rate: Payable in five (5) years with interest computed at six percent (6%) per annum. 8. Schedule of Payments: The amortization for fifty nine (59) months shall be Php 20.00 per month (or Php 240 per year), which represents the 6% interest on the principal amount computed annually. The principal amount of Php 4,000.00 shall become due only on the 60th month from first due month, plus the monthly interest of Php 20.00. Below is the schedule of amortization and application of payments:
Period Amount Due Applied as Interest Applied as Payment to Principal

Month 1- 59 Month 60

Php

20.00 4,020.00

Php 1,180.00 20.00

none Php 4,000.00

9. First Due Date: The first monthly amortization of the interest shall commence three (3) months following the grant of the assistance (i.e., assistance granted in May; first due date in August). 10. Maturity: The amount of the obligation shall mature at the end of the payment term or upon retirement, separation, permanent disability or death of the Borrower, if any of these contingencies occur before the expiration of the said term of the obligation. In which case, the entire principal amount of the assistance including all interests, shall be due and payable without need of demand or further notice. 11. Cancellation: Once the assistance is approved and the proceeds have been eCredited to the borrowers eCard, the Borrower can no longer cancel the transaction. 12. eCrediting of the proceeds: eCrediting shall be made in the UMID eCard or temporary eCard of the member not earlier than May 10, 2012. 13. Authority to Apply Payment: In case of maturity of this assistance and it remains outstanding either in whole or in part, both for principal and interest, the GSIS is authorized to collect, deduct or withhold from whatever loan proceeds or benefits that may be due the Borrower, his/her heirs, beneficiaries, assignees or successors-in-interest, the amount equivalent to the outstanding balance, inclusive of interest. Such authorization shall remain effective until full payment or any other outstanding obligation of the Borrower to the GSIS. It is expressly understood that any unpaid balance or outstanding obligation of the Borrower to the GSIS, by virtue of this assistance and/or other obligation, shall constitute a lien over any benefits/claims that may be due the Borrower. Should such benefits/claims from the GSIS be insufficient to cover the remaining balance, GSIS shall not be prevented from filing the necessary civil and administrative action(s) for recovery either against the borrower or his/her estate. 14. Recovery of Amount/s Credited in the eCard: GSIS shall have the right to recover by any legal means, any amount in the eCard account credited thereon by the GSIS due to fraud, misrepresentation or error on account of any transaction which the member may have with the GSIS. 15. Transfer/Change of Office: The Borrower shall immediately inform the GSIS of his/her transfer to any government office/agency and this application shall be sufficient authority for GSIS to effect collection through salary deduction from his/her new office/agency. 16. Attorneys Fees: Should the GSIS be compelled to refer the obligation or any portion thereof to an Attorney-at-Law for collection or to enforce any right hereunder against the Borrower or avail of any remedy under the law or this Agreement, the Borrower shall pay an amount equivalent to twenty five (25%) percent of all amounts outstanding and unpaid as and for attorneys fees and litigation expenses. 17. Venue: Any legal action, suit, or proceeding arising out or relating to this Agreement, shall be brought or instituted in the appropriate courts in the City of Pasay or such other venue at the exclusive option of GSIS. In the event the borrower initiates any legal action arising from or under this agreement, for whatever causes, the borrower agrees to initiate such action only in the City where the principal office of GSIS is located. 18. Notices: All notices required under this Agreement or for its enforcement shall be sent to the Office Address and/or at the Postal/Mailing Address indicated in the Personal Data portion of this application. The notices sent to any of the duly indicated addresses shall be valid and serve as sufficient notice to the Borrower for all legal intents and purposes.

I confirm that I have read and fully understood the EDUCATIONAL ASSISTANCE Terms and Conditions and undertake to comply with them.

______________________________________ SIGNATURE OF MEMBER/BORROWER TIN: _______________________________

___________________________ Date Signed

FOR GSIS USE ONLY

Received by / Date: Processed by / Date: Encoded by / Date: