HQP-PFF- 114

(For Household Employer)

MEMBERSHIP SAVINGS Pag-IBIG HOUSEHOLD EMPLOYER’S ID NUMBER

REMITTANCE FORM (MSRF)

(Print this form back to back on one single sheet of paper)

HOUSEHOLD EMPLOYER NAME

HOUSEHOLD EMPLOYER ADDRESS

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

Barangay Municipality/City Province ZIP Code

NAME OF KASAMBAHAYS MEMBERSHIP SAVINGS

MEMBERSHIP PERIOD MONTHLY
Pag-IBIG MID No./RTN ACCOUNT NO. REMARKS
PROGRAM Last Name First Name Name Ext. Middle Name COVERED COMPENSATION KASAMBAHAY HOUSEHOLD ER
TOTAL
(Jr., III, etc.) SHARE SHARE

TOTAL FOR THIS PAGE

GRAND TOTAL (if last page)

HOUSEHOLD EMPLOYER CERTIFICATION

I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best of my knowledge and belief. I further certify that my signature appearing herein is
genuine and authentic.

____________________________________________________ _____________________
NAME OF HOUSEHOLD EMPLOYER DATE
(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE. (Rev.00, 11/2013)

 GUIDELINES AND INSTRUCTIONS
a. Accomplish all entries in this form in BLOCK or CAPITAL LETTERS or accomplish this form in e. Failure and refusal of the household employer to pay or to remit the MS herein prescribed shall not
softcopy when making remittances to Pag-IBIG Fund or to any Accredited Collecting Agent on or prejudice the right of the covered Kasambahay to the benefits under the Fund. Such household
before the 10th day of every month starting from the date of membership registration. employer shall be charged a penalty equivalent to 1/10 of 1% per day of delay of the amount due
starting on the first day immediately following the due date until the date of full settlement.
b. MEMBERSHIP SAVINGS (MS)
Pag-IBIG Household Employer ID Number - a unique 12-digit number series assigned to registered
The membership savings of a Kasambahay, whose monthly compensation is less than Five
1 household employer.
Thousand Pesos (P5,000.00) shall be based on the following rates, and shall be for the account of
the household employer: Household Employer Name - refers to the name of person who engages and controls the services of
2 “Kasambahay” and is a party to the employment contract.
MONTHLY TOTAL MS RATE TO BE SHOULDERED
COMPENSATION BY HOUSEHOLD EMPLOYER Household Employer Address - indicate Unit/Room No., Floor, Building Name or Lot No., Block No.,
P1,500 and below 3% 3 Phase No. or House No. and Street Name, Subdivision, Barangay, Municipality/City, Province, and ZIP
Over P1,500 to P4,999 4% Code.

In case the Kasambahay’s gross monthly compensation is at least Five Thousand Pesos Pag-IBIG MID Number/RTN - indicate the Kasambahay’s assigned Pag-IBIG Membership ID (MID)
(P5,000.00), the Kasambahay and his Household Employer shall pay their corresponding 4 Number or Registration Tracking Number (RTN).
proportionate share in the MS. The maximum monthly compensation to be used in computing the
Kasambahay and corresponding Household Employer share shall not be more than P5,000.00 5 Account No. - indicate the Kasambahay’s assigned Account Number per Membership Program.

MONTHLY MS RATE TO BE MS RATE TO BE NOTE: In accomplishing the Account No. column, for Pag-IBIG I savings, indicate MID Number or RTN;
COMPENSATION SHOULDERED BY SHOULDERED BY for MP2, indicate the system-generated Account Number provided after successful enrollment.
KASAMBAHAY HOUSEHOLD EMPLOYER
P5,000 and above 2% 2% Membership Program - indicate if Membership Savings is for Pag-IBIG I or Modified Pag-IBIG II
7 program.
A Kasambahay may contribute more than what is required, however the household employer shall
only be mandated to contribute two percent (2%) of the monthly compensation of the Kasambahay Name of Kasambahays - indicate Kasambahay’s complete name in the following format: Last Name,
counterpart MS. In case the Kasambahay increases his/he MS, the Household Employer shall have
8 First Name, Name Extension (Jr., III, etc.), Middle Name
the option to match said increase or to contribute only what is required.
6 Period Covered - indicate the applicable month and year of MS remittance in the following format
c. Membership Savings (MS) payments to be remitted should be equal to the total amount reflected in (yyyymm).
the MSRF. Check payments should be made payable to Pag-IBIG Fund and shall be posted upon
clearing. Monthly Compensation - refer to the basic salary and other allowances, where basic salary includes,
9 but is not limited to, fees, salaries, wages, and similar items received in a month. Accomplish this portion
d. Household Employer with over remittance from previous payments shall be issued with a Notice of only when remitting the Kasambahay’s initial membership savings or if there are changes in monthly
Overpayment and Credit Memo. For remittances previously made for Kasambahay for whom compensation of the Kasambahay.
remittances should not have been made, the Household Employer shall request a refund subject to
the Fund’s verification and approval. The request shall be made not later than six (6) months from Membership Savings - indicate the amount of Kasambahay share under column 10 , the amount of
the time said remittance was made. 10 - 12 Household Employer share under column 11 , and the total amount of Kasambahay and Household
Employer share under column 12 . Do not round-off nor drop centavos.

1 Remarks - accomplish this portion only to report changes in the Kasambahay’s employment status and
13 to update any information regarding the Kasambahay. Indicate the appropriate code and effectivity date
in the following format (mm/dd/yy) on the space provided for. Please refer to the following codes and
2 examples:
3
N - Newly Hired Examples
L - Leave without Pay 1. N: 1/4/2012
7 RS - Resigned/Separated 2. L: 1/21/2012
4 5 6 8 9 10 11 12 13 RT - Retired 3. RS: 1/3/2012
D - Deceased 4. D: 1/14/2012
O - Others, please specify reason

14 Indicate the total amount of membership savings per page.

15 Indicate the grand total amount of membership savings if this is the last page.
14
15

16 16 Household Employer Certification - to be accomplished and duly signed by the Household Employer.