Date of Application
SWORN APPLICATION TO PURCHASE A HOUSE AND LOT PACKAGE/HOUSING UNIT
UNDER THE GOVERNMENT EMPLOYEES HOUSING PROGRAM
THE REGIONAL MANAGER
Thru: The District Manager
Sir:/Madame:
In accordance with NHA rules and regulations which I and my family agree to comply with faithfully, I hereby
apply: (please check)
A.1. FOR PURCHASE OF HOUSE AND LOT PACKAGE under the GEHP thru
Outright/Cash Sale Staggered Cash In-House Financing (Installment Payment)
End-User Financing (MTO-Pag-Ibig) Straight Amortization
Escalating Amortization
A.1.1 Reservation Fee – P20,000.00 non-refundable (if applicable)
PROJECT NAME (see attached Annex for list):
A.2. TYPE OF HOUSING
2-Storey Duplex Low-Rise Building/Condominium
Storey Duplex
A.3. As Government Employee of (please specify)
I. APPLICANT’S IDENTITY: (For female applicant/spouse, give complete maiden name)
NAME:
(Last) (First) (Middle) (Mother's Surname)
Residence/Address:
Date of Birth: Place of Birth: Civil Status: Citizenship: Sex: Female
Sector with Special Privilege: Solo Parent ID No. Male
Senior Citizen ID No.
Person with Disability ID No.
Contact Numbers (Residence) Office
E-mail Address:
TIN No. GSIS/SSS/Pag-IBIG Policy No.
Name of Spouse:
(Last) (First) (Middle) (Mother's Surname)
Date of Birth Place of Birth Sex: Female
Male
II. APPLICANT’S EMPLOYMENT STATUS
Nature of Employment:
Name of Agency/ Corporation:
For Military/Police Personnel:
Rank: Serial No./Badge No. Branch of Service:
Position: Place of Assignment:
Salary Grade: Gross Monthly Income: (at the time of application)
Date Hired: Mother Unit:
No. of years In the Government:
For Government Employees:
Position:
Salary Grade: Gross Monthly Income:
Date Hired:
No. of years In the Government:
2024 Revision
III. APPLICANT'S FAMILY COMPOSITION (add additional page if necessary):
NAME SEX RELATION TO CIVIL STATUS AGE EMPLOYMENT/SOURCE
APPLICANT OF INCOME
___________________ ______ _____________ ___________ _____ _____________________
___________________ ______ _____________ ___________ _____ _____________________
___________________ ______ _____________ ___________ _____ _____________________
___________________ ______ _____________ ___________ _____ _____________________
___________________ ______ _____________ ___________ _____ _____________________
IV. APPLICANT’S TOTAL FAMILY INCOME PER MONTH: (PhP )
V. FAMILY REAL PROPERTY HOLDINGS: (please underline)
I have never availed of any form of government housing assistance, nor violated Section 14 of RA 7279 (YES/ NO)
VI. CERTIFICATIONS
I/We certify that the foregoing information/statement is to my/Our knowledge, true, correct, complete, and
updated. The signature/s appearing above my/our name/names below is/are genuine.
I/We authorize National Housing Authority (NHA) or its duly authorized representative to verify necessary
information or data (i.e. certificate of employment, pay slips and income tax return) with the concerned
government agencies or third parties including banks and other financial institutions from whom NHA had obtained
information.
I/We hereby agree that any misrepresentation of a material fact is a ground for disapproval of the
application, cancellation of the loan, and shall be a cause for the total outstanding obligation to be due and
demandable if found later to be false and shall be subject to other sanctions provided in existing NHA guidelines.
I/We agree to notify NHA of any material change affecting the information contained herein. I/We agree that all
information obtained by NHA) shall remain its property whether or not the loan is granted.
I/We further agree to be bounded by the current and general policies of NHA and those that the NHA may
adopt in the future, that may have relation to or in any way affect my/our loan.
I/We understand that the processing/service/filing fee, notarial and all other incidental fees pertaining to the
registration of mortgage on property shall be for my/our account.
SIGNATURE OVER PRINTED NAME OF BORROWER SIGNATURE OVER PRINTED NAME OF SPOUSE
DATE DATE
SUBSCRIBED AND SWORN to before me in Philippines, this day of
, AFFIANT, having exhibited to me, his/her ID No. issued
on at .
NOTARY PUBLIC
Doc. No.
Page No.
Book No.
Series of .
Note: Please provide complete information and write legibly in PRINT /BLOCK LETTERS
I hereby certify that the information provided are true and correct to the best of my knowledge and belief.
I am giving my free, voluntary and unconditional consent to the collection and processing of all information/personal data and include
the same in their database and to update the same from time to time without further asking my written consent.
I understand further, that NHA shall keep my information/personal data in strict confidence and that the collection and processing of
all information/personal data may be used for any legal purpose and in accordance with Republic Act (R.A.) 10173, otherwise known
as the “Data Privacy Act of 2012”.
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