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(informant’s signature over printed name)
informabt signature

signature over printed name
reasons for refferal

participant's signature over printed name
name and signature of participant

informant’s signature
informants signature

parents signature over printed name
adviser

signature over printed name in tagalog
pirma sa nakalimbag na pangalan sa tagalog

sign over printed name
umaasa sa impormasyon

printed name
nakalimbag na pangalan

printed name and signature of the applicant
signature verified

authority to deducti hereby authorize you to deduct from my salary the sum of ____________________________ (p_____________) for ___consecutive months beginning ______________________ andtoremit the said amount tothephilippine public school teachers association(ppsta)in consideration of myloan in the principal amount of ____________________ (p_____________) plus add-on interest and other charges, which was granted to me on _______________________.this authorization is valid and binding until my aforementioned loan is fully paid for or upon writtennoticeof its discontinuance bythe ppsta.promissory notefor value received, the undersigned promises to pay to the order of the philippine public school teachers association at its officelocated at245 banawe st. quezon city, philippines,through apds,the sum of pesos ______________________________ (p_______________) with interest rate of ___________ percent (___%) per annum, to be paid in equal monthly installments in the amount of p _____________ for ________ months, beginning _____________________ andending _________________.default in the payment for six (6) consecutive installments shall render the entire unpaid balance due and demandable.in witness whereof, i have hereunto set my hand this ____day of ___________________at ___________________.___________________________________________(signature over printed name of borrower)employee no._________division no.____ station no.____ctc no. school or station address____________________________date issued_________________________________________________place issuedhome address: ____________________________________telephone no.: _________________________________________________acknowledgmentrepublic of the philippines)city of _____________________) s.sx-----------------------------------------)before me, a notary public in and for the above jurisdiction, this ___day of __________________ 200___ personally appeared _________________________________ with community tax certificate no. ______________ issued at _____________________________ on ____________________ known to me and tome known to be the same personwho executed the foregoing instrument and acknowledgedto me that the same is his/her free and voluntary act and deed.witness my hand and notarialseal on the dateandplace first above-written.notary publicdoc. no.________________page no.________________book no. _______________series of ________________
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