THE MEDICAL CITY

Ortigas Avenue, Pasic City

COST AND PAYROLL ADMINISTRATION DEPARTMENT

RETIREMENT LOAN APPLICATION FORM

PART I.
Instruction for Retirement Loan Application

A. Eligibility

 Retirement Loan is available only for all regular employees who have rendered at least one (1) year of service.
 Partial Payment (50%) - For employees with existing loan who’s applying for loan renewal.
 Account Receivable - Application will still undergo evaluation from Payroll Section.
 With at least Php. 2,000.00 Take Home Pay, after deducting the monthly amortization.

B. List of Requirements

a. Retirement Loan Application Form (FIN-RLAF-CST-002) - 2 Copies

b. Promissory Note - 2 Copies
c. Surety Agreement - 4 Copies
d. Current One (1) Month Pay Slip (For Rank and File Employees Only)
e. 1 Valid ID (Company) – Government issued IDs such as SSS, UMID, Passport, Driver’s License, PRC License
can also be used in case the company ID is dilapidated or not readable.
 Photocopy (Front and Back)
 Indicate in the photocopy the following: Present Address, Birthdate, and Place of Birth.

C. Instructions

1. Application

1.1. Print the form via IT Suite Print Forms.

1.2. Accomplish the Retirement Loan Application Form (FIN-RLAF-CST-002) along with the supporting documents.
1.3. Upon completion, photocopy the forms as stated above.
th
1.4. Submit the forms to Cost and Payroll Department (CST) – Payroll Section, CST Payroll Assistant, 15 Floor,
Nursing Tower II.
1.5. Application forms submitted to CST will be processed (review and approval) by batch based on the following
schedule:

Date of Request Processing Schedule Follow-up Schedule

st th th
1 - 15 of the Month 16 day of the Same Month One (1) month from the Processing
th th st
16 - 30 of the Month 1 day of the Succeeding Month Schedule

1.6. Approved loan amount will be credited to your bank account by Bank of the Philippine Islands (BPI) upon
approval.

2. Renewal

2.1. Settle the remaining unpaid amount of the previous loan in full prior to filing of loan renewal.

D. Terms and Mode of Payment

Loanable
Loan Applicant Designation Tenure Duration Mode of Payment
Amount
Nurses 1 Year Above Basic Salary 12 Months Installment Basis
Rank and File Administrative, Ancillary, and 1-9 Years (2X) 24 Months /Salary Deduction
Employees Support/Back Offices 10 Years Above Php 80,000.00 60 Months
Confidential
Details to be discussed by Payroll Section Head with the employee.
Employees

FIN-RLAF-CST-002 Page 1 of 4 Rev5Iss6 11-May-2020

PART II.

NAME OF APPLICANT DATE OF APPLICATION

DEPARTMENT POSITION

BASIC SALARY DATE OF EMPLOYMENT

REASON/S FOR LOAN

With pending application for a loan with any institution (i.e. Private, Governmental, any Individual)?  YES  NO
TYPE OF LOAN/S DEDUCTION/S AMOUNT

With other payroll deductions?  YES  NO

TYPE OF DEDUCTION/S AMOUNT/MONTH

I hereby certify that the information stated above is true and correct. I authorize The Medical City to validate the information I have given. I understand
that any incorrect information given shall void my loan application.
PREPARED BY RECOMMENDED BY

Signature Over Printed Name/Date Signature Over Printed Name/Date

APPLICANT DEPARTMENT HEAD

AUTHORITY FOR PAYROLL TO DEDUCT

In consideration of my loan application with the fund and for which I bind myself liable in the amount of
PESOS (Php. ). I hereby respectfully request that
the necessary collection from my salary every in the amount of Php be undertaken for remittance to be fund up to the
extent of the loan amortization only, for a period of months or until the same is fully paid.

PREPARED BY

Signature Over Printed Name/Date

APPLICANT
ATTESTED BY ATTESTED BY

Signature Over Printed Name/Date Signature Over Printed Name/Date

1ST GUARANTOR 2ND GUARANTOR

FOR HUMAN RESOURCES DEPARTMENT AND PAYROLL USE ONLY

LOANABLE AMOUNT:
VERIFIED BY NOTED BY APPROVED BY

Signature Over Printed Name/Date Signature Over Printed Name/Date Signature Over Printed Name/Date
PAYROLL - STAFF-IN-CHARGE CST - DEPARTMENT HEAD HCMG - GROUP HEAD

FIN-RLAF-CST-002 Page 2 of 4 Rev5Iss6 11-May-2020

PART III.

PROMISSORY NOTE

Promissory Note No. Manila, Philippines

Date Due, 20

FOR VALUE RECEIVED, I promised to pay THE MEDICAL CITY in Pasig City, Philippines, the sum of
PESOS (P ), Philippine currency,
with interest at the rate of percent ( ) per annum, until fully paid in installment as follows:

( ) installments at
P per starting .

Upon default of payment of any installments when due, all the other installments shall be become due
and payable and shall bear interest at the rate of per annum.

Interest unpaid when due shall be added to and become part of the principal and shall likewise bear the same
interest as stipulated in the next preceding paragraph.

The undersigned hereby authorizes and empowers THE MEDICAL CITY to set off, without notice, what is due
it, irrespective of the date of maturity, whether or not the obligation is due from whatever funds I may have with THE
MEDICAL CITY.

I hereby waive any diligence, presentment, demand protest or notice of non-payment or dishonor with respect
to this note or any extension thereof. Holder may accept partial payment reserving his right against each and all
endorses.

In case it shall necessary to collect this note by or through an attorney-at-law, the maker shall pay 25% of the
amount due on the note as attorney’s fees, exclusive of all costs, fees and damages allowed by law.

In case of litigation, complete jurisdiction is vested on the Metropolitan Trial Court of Manila or the Regional
trial Court of Manila, as the case may be, to determine any and all questions arising hereunder.

AMOUNT OF LOAN :
DOC. STAMPS :
SERVICE FEE :

Signature over Printed Name/Date & Time

TIN No. / Res. Cert. No.

Issued at
On

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PART IV.

SURETY AGREEMENT

We and
hereby acknowledge our obligations as co-borrower/s of
In the event of failure to collect any of the foregoing amounts, We hereby undertake to pay the outstanding balance
of the loan evidenced by the foregoing PN in the amount of monthly.
We hereby authorize of to deduct from our salaries what is due
The Medical City for the period for purposes of collection.

It is understood that our liability as co-borrower/s is joint and several with the due principal borrower.

IN WITNESS WHEREOF WE have hereunto set our hands this day of,
, 20 in the City/Municipality of Province of ,
Philippines.

1st Guarantor/s Signature Over Printed Name

2nd Guarantor/s Signature Over Printed Name

ACKNOWLEDGEMENT

Republic of the Philippines)

Pasig City ) S.S.

BEFORE ME, A notary Public for and in Pasig City, personally appeared
, and
,with Tax Identification Nos.,
, ,and respectively, both of whom are known to me to be the
same persons who executed the foregoing promissory note and they acknowledged to me that the same is of their
own free and voluntary act and will.

Signature of Lawyer
Notary Public

DOC. NO. :
BOOK NO. :
PAGE NO. :
SERIES OF :

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