GSIS
GSIS
WARNING: Direct or indirect commission of fraud, collusion, falsification, misrepresentation of facts, or any other kind
of anomaly in the accomplishment of this form, or in obtaining any benefit under this application shall be subject to
administrative, civil and/or criminal action.
Name of Applicant
Mailing/Residential Address
LOAN AMOUNT (Please encircle your choice or indicate preferred loan amount)
Basic Monthly Salary TYPE OF LOAN:
1 2 3 4 5 6 7 8 9 10 11 12 13 14
mo. mos. mos. mos. mos. mos. mos. mos. mos. mos. mos. mos. mos. mos. New
Renewal
Preferred Loan Amount (Any amount lower than the maximum loan) Php ______________________________ (Please check choice)
I undertake to pay the loan within ________________ years. (Please indicate applicable loan term.)