AFPMBAI

INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE

Name of Member
:
PNP Account Code
:
Unit Assignment/Code
Payslip presented for previous loan subject for renewal/restructuring
(Month Year)
:
Assessed Insurance Prem : ____________________________________
Payment Terms
:
NTHP based on latest Payslip attached : __________________________
New Monthly Amortization : _____________________________________
Adjusted NTHP after all deductions : ______________________________
(including witholding Taxes)
Name of Insurance Representative/Evaluator : ______________________

Signature over Printed Name

Date assessed
--------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :______________
_Application form to include Authority to Deduct, Completely filled-up
_Previous Loan Record
_Payslip used for previous loan application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : __________________________________________
REMARKS : _________________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
:
PNP Account Code
:
Unit Assignment/Code
Payslip presented for previous loan subject for renewal/restructuring
(Month Year)
:
Assessed Insurance Prem : ____________________________________
Payment Terms
:
NTHP based on latest Payslip attached : __________________________
New Monthly Amortization : _____________________________________
Adjusted NTHP after all deductions :

(including witholding Taxes)

Name of Insurance Representative/Evaluator : ______________________

Signature over Printed Name

Date assessed
----------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :_______________
_Application form to include Authority to Deduct, Completely filled-up
_Previous Loan Record
_Payslip used for previous loan application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : _______________________________________
REMARKS : ______________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
:
PNP Account Code
:
Unit Assignment/Code
Payslip presented for previous loan subject for renewal/restructuring
(Month Year)
:
Assessed Insurance Prem : __________________________________
Payment Terms
:
NTHP based on latest Payslip attached : ________________________
New Monthly Amortization : ___________________________________
Adjusted NTHP after all deductions : ____________________________
(including witholding Taxes)
Name of Insurance Representative/Evaluator : ____________________

Signature over Printed Name

Date assessed
--------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :______________
_Application form to include Authority to Deduct, Completely filled-up
_Previous Loan Record
_Payslip used for previous loan application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : ________________________________________
REMARKS : _______________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
:
PNP Account Code
:
Unit Assignment/Code
:
Payslip presented for previous loan subject for renewal/restructuring
(Month Year)
:
Assessed Insurance Prem : __________________________________
Payment Terms
:
NTHP based on latest Payslip attached : ________________________
New Monthly Amortization : ___________________________________
Adjusted NTHP after all deductions : ____________________________

(including witholding Taxes)

Name of Insurance Representative/Evaluator : ____________________

Signature over Printed Name

Date assessed
--------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :______________
_Application form to include Authority to Deduct, Completely filled-up
_Previous Loan Record
_Payslip used for previous loan application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : ________________________________________
REMARKS : _______________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
: ______________________________________
PNP Account Code
: ______________________________________
Unit Assignment/Code
: ______________________________________
Payslip presented (Month Year) : ________________________________
Assessed Insurance Prem : ____________________________________
Payment Terms
: ______________________________________
NTHP based on latest Payslip attached : __________________________
New Monthly Amortization : _____________________________________
Adjusted NTHP after all deductions : ______________________________
(including witholding Taxes)
Name of Insurance Representative/Evaluator : ______________________

Signature over Printed Name

Date assessed
--------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :______________
_Application form to include Authority to Deduct, Completely filled-up
_Previous Loan Record
_Payslip used for previous loan application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : __________________________________________
REMARKS : _________________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
: ______________________________________
PNP Account Code
: ______________________________________
Unit Assignment/Code
: ______________________________________
Payslip presented (Month Year) : ________________________________
Assessed Insurance Prem : ____________________________________
Payment Terms
: ______________________________________
NTHP based on latest Payslip attached : __________________________
New Monthly Amortization : _____________________________________

Adjusted NTHP after all deductions :

(including witholding Taxes)
Name of Insurance Representative/Evaluator : ______________________

Signature over Printed Name

Date assessed
----------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :_______________
_Application form to include Authority to Deduct, Completely filled-up
_Payslip used for insurance application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : _______________________________________
REMARKS : ______________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
: ____________________________________
PNP Account Code
: ____________________________________
Unit Assignment/Code
: ____________________________________
Payslip presented (Month Year) : ______________________________
Assessed Insurance Prem : __________________________________
Payment Terms
: ____________________________________
NTHP based on latest Payslip attached : ________________________
New Monthly Amortization : ___________________________________
Adjusted NTHP after all deductions : ____________________________
(including witholding Taxes)
Name of Insurance Representative/Evaluator : ____________________

Signature over Printed Name

Date assessed
--------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :______________
_Application form to include Authority to Deduct, Completely filled-up
_Previous Loan Record
_Payslip used for previous loan application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : ________________________________________
REMARKS : _______________________________________________

AFPMBAI
INSURANCE EVALUATION SHEET FOR ADDITIONAL INSURANCE
Name of Member
: ____________________________________
PNP Account Code
: ____________________________________
Unit Assignment/Code
: ____________________________________
Payslip presented (Month Year) : ______________________________
Assessed Insurance Prem : __________________________________
Payment Terms
: ____________________________________
NTHP based on latest Payslip attached : ________________________
New Monthly Amortization : ___________________________________

Adjusted NTHP after all deductions : ____________________________

(including witholding Taxes)
Name of Insurance Representative/Evaluator : ____________________

Signature over Printed Name

Date assessed
--------------------------------------------------------------------------------------------RFSO Verification/Checklist :
Date :______________
_Application form to include Authority to Deduct, Completely filled-up
_Payslip used for insurance application
_Payslip for three (3) consecutive months
_PNP ID (photocopy with specimen signature)
_Withholding Tax updated
_Others, as needed : ________________________________________
REMARKS : _______________________________________________