PFF039 Member'SDataForm V03

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MEMBERS DATA

FORM (MDF)





FOR Pag-IBIG FUND USE ONLY

Pag-IBIG MID NUMBER



REGISTRATION TRACKING NUMBER







INSTRUCTIONS

1. Accomplish this form in two (2) copies. If registration is thru online, the
form should be printed back to back on one single sheet of paper.
2. Type or print all entries in BLOCK or CAPITAL LETTERS.
3. The NAME EXTENSION shall refer to JR., II, III and the like.
4. Indicate the full name of your FATHER and MOTHER as they appear in
your birth certificate.
5. Accomplish only the PRESENT HOME ADDRESS if it is different from
the PERMANENT HOME ADDRESS.
6. On the CONTACT DETAILS portion, indicate at least one (1) contact
number.
7. On the OCCUPATION portion, indicate occupation based on the provided List of
Occupation.
8. All fields which are marked with asterisk (*) are mandatory.
9. On the HEIRS portion, the provision on the Laws on Succession, as provided in
the New Civil Code of the Philippines, as amended by the New Family Code, shall
be observed.
10. For any subsequent change of information, please secure and accomplish two (2)
copies of the Members Change of Information Form (MCIF, [HQP-PFF-049]) and
submit to the concerned Pag-IBIG Branch.





*MEMBERSHIP CATEGORY
MANDATORY
EMPLOYED PRIVATE
EMPLOYED GOVERNMENT
EMPLOYED PRIVATE HOUSEHOLD




OVERSEAS FILIPINO WORKER (OFW)
SELF-EMPLOYED (SE)
OTHER WORKING GROUP (OWG)



VOLUNTARY
EMPLOYED
INDIVIDUAL PAYOR (IP)
OTHER WORKING GROUP (OWG, if income is less than P1,000.00)


LAST NAME FIRST NAME
NAME
EXTENSION
(e.g. Jr., II)
MIDDLE NAME
NO MIDDLE NAME
(check if applicable only)
*MEMBER


FATHER


*MOTHER (Maiden Name)


*SPOUSE (If Married)


MEMBERS NAME AS
APPEARING IN THE BIRTH
CERTIFICATE


*DATE OF BIRTH




m m d d y y y y
*MARITAL STATUS
Single/Unmarried Widow/er Annulled
Married Legally Separated

TAXPAYERS IDENTIFICATION NUMBER (TIN)






SSS/GSIS NUMBER







EMPLOYEE NUMBER







For AFP/PNP Employee, Serial/Badge No.




For DepEd Employee, Division Code-Station Code




*PLACE OF BIRTH
(City/Municipality/Province/Country)
(Please indicate country if born outside the
Philippines)

CITIZENSHIP
*SEX
Male
Female
HEIGHT

______ (m)
WEIGHT

______ (kg)
PROMINENT DISTINGUISHING FACIAL FEATURES
(Ex. Moles, Scars, etc.)

COMMON REFERENCE NUMBER (CRN)
(If Available)




FREQUENCY OF MS PAYMENT
(If payment of contribution is not thru payroll deduction)



Monthly Semi-Annually
Quarterly

ADDRESS AND CONTACT DETAILS
*PERMANENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name Subdivision

(Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NUMBER
Home


*Cell Phone


Business (Direct Line)


Business (Trunk Line) Local


*Email Address



Barangay Municipality/City Province/State/Country (if abroad) ZIP Code

PRESENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name Subdivision

Barangay Municipality/City Province/State/Country (if abroad) ZIP Code

*PREFERRED MAILING ADDRESS

Present Home Address Permanent Home Address


Employer/Business Address

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
(Rev. 02, 01/2013)




HQP-PFF-039







PRESENT EMPLOYMENT DETAILS (If with more than one (1) employer, use separate sheet and follow format below)
*EMPLOYER/BUSINESS NAME





MONTHLY INCOME
Basic



+

Allowances/Others


=

Total Mo. Income


*EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No.
Street Name Subdivision Barangay
*TYPE OF WORK (For OFWs only)

Land-based Sea-based
Municipality/City Province State/Country (If abroad) ZIP Code

OFFICE ASSIGNMENT


Head Office Branch ____________
*OCCUPATION *EMPLOYMENT STATUS
Permanent/Regular Contractual
Casual Project-based
Part-time/Temporary



*FROM

m m y y y y


TO

m m y y y y
*PREVIOUS EMPLOYMENT FROM DATE OF Pag-IBIG FUND MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME


OFFICE ASSIGNMENT
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS

FROM

m m y y y y
TO

m m y y y y
EMPLOYER/BUSINESS NAME


OFFICE ASSIGNMENT
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS

FROM

m m y y y y
TO

m m y y y y
EMPLOYER/BUSINESS NAME


OFFICE ASSIGNMENT
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS

FROM

m m y y y y
TO

m m y y y y
HEIRS (In case of death, Fund benefits shall be divided among the members heirs in accordance with the New Civil Code as amended by the New Family Code) (Use another sheet if necessary)
LAST NAME FIRST NAME
NAME
EXTENSION

MIDDLE NAME

NO MIDDLE NAME
(Check only if applicable)
RELATIONSHIP DATE OF BIRTH







m m d d y y y y







m m d d y y y y







m m d d y y y y







m m d d y y y y





I HEREBY CERTIFY THAT THE INFORMATION GIVEN AND ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT.




_________________________________ _________________
SIGNATURE OF MEMBER DATE










DISCLAIMER: Membership registration with the Fund does not automatically qualify a Pag-IBIG member to avail of the Funds various loan
programs. A Pag-IBIG member must satisfy the eligibility requirements and comply with the documentary requirements, which is
subject to verification and approval.

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