Office of the President NATIONAL HOUSING AUTHORITY Elliptical Road, Diliman, Quezon City AFP/PNP MILITARY HOUSING PROJECT

SWORN APPLICATION FORM

Date: ______________ THE GENERAL MANAGER NHA, Diliman, Quezon City SIR: In accordance with NHA rules and regulations which I and my family agree to comply with faithfully, I hereby apply to purchase (Please check): 22 sq m loaftable row / 40 sq m Lot CHOICE OF LOCATION: _(1) Tagum City_ _(2) Davao City_ ______________ Installment: ______ (Pls. rank 1-3 with No. 1 as 1 choice and No. 3 as last choice)
st

Mode of Payments: Cash: _______ A.

With Equity: ______

No. of Installments: _______

APPLICANTS IDENTITY: (For female applicants/spouse, indicate maiden name) NAME: PO1 Glorio Ortega Dumandan Jr. 205670 PNP____ (Rank) (First) (Middle) (Last) (Serial Number) (Br of Svc) Home Address: Prk. 5, Brgy. Bala, Magsaysay, Davao del Sur_________ AFP/PNP ID NO.: ___12A100037_____ Issued on: ____January 10, 2012____ Issued at: _______Camp Crame, Quezon City___ Contact No.: ____0946-4489-631_____ TIN No.: ____293-563-940-000_____ Place & Date of Birth: ____Brgy. Bala, Magsaysay, Davao del Sur / May 16, 1987___ Unit/Office: ____11RPSB, PRO 11_____ Civil Status: ____Single____ Name of Spouse: ___N/A___

B.

APPLICANTS FAMILY COMPOSITION: NAME Glorio Mara Dumandan_____ Erlinda Ortega Dumandan___ Glorelyn Ortega Dumandan__ _ Lynglor Dumandan Lakina____ _ Glenn Boy Ortega Dumandan_ Eglorio Ortega Dumandan____ RELATION TO APPLICANT ________Father_______ _______Mother_______ ________Sister________ ________Sister________ _______Brother_______ _______Brother_______ CIVIL STATUS __Married__ __Married__ __Single____ __Married__ __Married__ __Single____ AGE 57 58 30 29 25 20

C. D.

APPLICANTS FAMILY INCOM PER MONTH: ____P14,834.00___ FAMILY PROPERTY REAL HOLDINGS: I certify that my spouse and I ( ) Do not own nor are holders of a contact to buy any lot/dwelling unit in the Philippines ( ) Have never availed of any government housing assistance nor violated Section 14 of RA 7279 ( ) Do not own nor are holders of a contract to buy real property in the Philippines I hereby certify that I am making this application for the sole purpose of acquiring a residential unit for my family and not as DUMMY or AGENT of any other party. Any false statement given by me hereinabove shall be sufficient cause for the cancellation of the award and contract that maybe executed by NHA in my favor as a result of this application and the forfeiture of all payments that may have been therefore without prejudice to any administrative, criminal or civil action that maybe brought by the NHA against me in accordance with existing laws.

_________________________ (Signature of Applicant) SUBSCRIBED AND SWORN to before me in ____________, Philippines, this ________ day of _____________ ___2013___. AFFIANT, having exhibited to me his/her __Philippine National Police (PNP)___ ID as stated above.

NOTARY PUBLIC
Doc. No.: ________________ Page No.: ________________ Book No.: ________________ Series of 20_______________