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Application for Direct House Repair and/or Improvement Loan
SSS application loan form for House repair or Improvement
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
APPLICATION NUMBER
SOCIAL SECURITY SYSTEM
(TO BE FILLED OUT BY SSS)
APPLICATION FOR DIRECT
HOUSE REPAIR AND/OR IMPROVEMENT LOAN
(01-2013)
(08-2013)
THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE
PLEASE READ INSTRUCTIONS & REMINDER AT THE BACK AND THE ATTACHED TERMS AND CONDITIONS & CHECKLIST OF REQUIREMENTS BEFORE FILLING
OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK OR BLUE INK ONLY.
PART I - TO BE FILLED OUT BY APPLICANT
A. PRINCIPAL APPLICANT'S DATA
SS NUMBER
COMMON REFERENCE NUMBER (IF ANY)
(LAST NAME)
NAME
DATE OF BIRTH (MMDDYYYY)
(FIRST NAME)
(MIDDLE NAME)
(RM./FLR./UNIT NO. & BLDG. NAME)
LOCAL ADDRESS
(SUBDIVISION)
(SUFFIX)
(HOUSE/LOT & BLK NO.)
(BARANGAY/DISTRICT/LOCALITY)
GENDER
TAX IDENTIFICATION NUMBER (IF ANY)
(STREET NAME)
(CITY/MUNICIPALITY)
(PROVINCE)
ZIP CODE
CIVIL STATUS
MALE
FEMALE
SINGLE
TELEPHONE NO.(AREA CODE + TEL. NO.)
MARRIED
OTHERS (PLEASE INDICATE) ___________________
WIDOWED
MOBILE/CELLPHONE NUMBER
E-MAIL ADDRESS
FOREIGN ADDRESS (FOR OVERSEAS FILIPINO WORKER)
COUNTRY
ZIP CODE
B. PRINCIPAL APPLICANT'S EMPLOYER DATA (IF LOCALLY EMPLOYED)
EMPLOYER NUMBER
TAX IDENTIFICATION NUMBER (IF ANY)
TYPE OF EMPLOYER
BUSINESS
HOUSEHOLD
EMPLOYER NAME
(RM./FLR./UNIT NO. & BLDG. NAME)
EMPLOYER ADDRESS
(SUBDIVISION)
(HOUSE/LOT & BLK. NO.)
(BARANGAY/DISTRICT/LOCALITY)
(STREETNAME)
(CITY/MUNICIPALITY)
TELEPHONE NUMBER (AREA CODE + TEL. NO.)
E-MAIL ADDRESS
SS NUMBER
COMMON REFERENCE NUMBER (IF ANY)
(PROVINCE)
ZIP CODE
WEBSITE (IF ANY)
C. SPOUSE'S DATA (IF APPLICABLE)
(LAST NAME)
NAME
DATE OF BIRTH (MMDDYYYY)
(FIRST NAME)
EMPLOYER NUMBER
TAX IDENTIFICATION NUMBER (IF ANY)
(MIDDLE NAME)
TAX IDENTIFICATION NUMBER (IF ANY)
(SUFFIX)
TYPE OF EMPLOYER
BUSINESS
HOUSEHOLD
EMPLOYER NAME
EMPLOYER ADDRESS
(RM./FLR./UNIT NO. & BLDG. NAME)
(SUBDIVISION)
(HOUSE/LOT & BLK. NO.)
(BARANGAY/DISTRICT/LOCALITY)
TELEPHONE NUMBER (AREA CODE + TEL. NO.)
(CITY/MUNICIPALITY)
E-MAIL ADDRESS
(STREETNAME)
(PROVINCE)
ZIP CODE
WEBSITE (IF ANY)
D. LOAN PARTICULARS
AMOUNT APPLIED FOR
TERM (NUMBER OF YEARS)
P
5
10
LOAN TYPE
15
20
REGULAR
DISASTER-RELATED ____________
E. COLLATERAL
A. LAND
OCT/TCT/CCT NO.
LOCATION
LOT AREA (SQ.M.)
B. BUILDING
DESCRIPTION
FLOOR AREA (SQ.M.)
Perforate Here
Republic of the Philippines
SOCIAL SECURITY SYSTEM
APPLICATION FOR DIRECT HOUSE REPAIR AND/OR IMPROVEMENT LOAN
ACKNOWLEDGEMENT STUB
SS NUMBER/COMMON REFERENCE NUMBER
NAME OF MEMBER
(LAST NAME)
(FIRST NAME)
(MIDDLE NAME)
RECEIVED BY
SIGNATURE OVER PRINTED NAME
POSITION TITLE
Perforate here
DATE & TIME
RIGHT THUMB
BRANCH
RIGHT INDEX
(SUFFIX)
MLPXXX-0000 (mm-yy)
(03-2009)
F. CERTIFICATION
I/We hereby certify that any misrepresentation of a material fact is a ground for disapproval of the application, cancellation of the loan, or
foreclosure of the mortgage, as the case may be.
The foregoing statement made for the purpose of obtaining a direct house repair and/or improvement loan are true, correct and complete
to the best of my/our knowledge and belief; hence, I/we agree that the same shall be considered as part of the mortgage contract.
I/We further certify that I/we have read and understood all the information and requirements pertaining to this loan, as well as conform to
the attached TERMS AND CONDITIONS of the House Repair and/or Improvement Loan, and consider the same as part of the mortgage
contract.
SIGNATURE OVER PRINTED NAME OF
PRINCIPAL APPLICANT
DATE
SIGNATURE OVER PRINTED NAME OF SPOUSE
OF PRINCIPAL APPLICANT
DATE
PART II - TO BE FILLED OUT BY SSS
RECEIVED BY
SIGNATURE OVER PRINTED NAME
POSITION TITLE
DATE & TIME
BRANCH
INSTRUCTIONS
Fill-out this form in two (2) copies.
Place a checkmark on the applicable box.
Always indicate "N/A" or "Not Applicable", if the required data is not applicable.
Present identification document/s.
Filed by member
▪ Social Security (SS) Card or Unified Multi-Purpose ID (UMID) Card or Passport or Professional Regulation Commission (PRC)
Card or Seaman's Book (both with signature and at least one (1) with photo)
Filed by authorized representative
▪ Representative's SS Card or UMID Card or Passport or PRC Card or Seaman's Book or two (2) valid IDs (both with signature and
at least one (1) with photo)
▪ Member's SS Card or UMID Card or Passport or PRC Card or Seaman's Book or two (2) valid IDs (both with signature and at
least one (1) with photo)
Filed by employer/company representative
▪ Employer/company representative's SS Card or UMID Card or Passport or PRC Card or Seaman's Book or two (2) valid IDs (both
with signature and at least one (1) with photo)
▪ Member's SS Card or UMID Card or Passport or PRC Card or Seaman's Book or two (2) valid IDs (both with signature and at
least one (1) with photo)
5. Submit this form together with the documentary requirements (please refer to the attached Checklist of Requirements For Direct
House Repair And/Or Improvement Loan) to the nearest SSS branch office.
6. This form can be downloaded thru the SSS Website at www.sss.gov.ph .
1.
2.
3.
4.
REMINDER
Verification of status may be made thru the SSS Website at www.sss.gov.ph or contact our Call Center at 9206446 up to 55
or 9177777.
WARNING
ANY PERSON WHO MAKES ANY FALSE STATEMENT IN THIS APPLICATION OR SUBMITS ANY FALSIFIED DOCUMENT IN
CONNECTION WITH THE APPLICATION FOR LOAN WITH THE SSS SHALL BE LIABLE CRIMINALLY UNDER SECTION 28 OF
R.A. 8282 OR UNDER PERTINENT PROVISION OF THE REVISED PENAL CODE OF THE PHILIPPINES.
