PH Pag-IBIG HQP-PFF-039 Form - Fill, Sign Online, Download & Print - No Signup
MEMBER’S DATA FORM
(MDF)
FOR Pag-IBIG Fund USE ONLY
Pag-IBIG MID NUMBER
REGISTRATION TRACKING NUMBER
INSTRUCTIONS
1. Accomplish this form in one (1) copy only. If registration is thru online, the form
should be printed back to back on a single sheet of paper.
2. Type or print all entries in BLOCK or CAPITAL LETTERS.
3. All fields marked with asterisk (*) are mandatory.
4. On the “OCCUPATIONAL STATUS” portion, if not employed or purpose is
pre-employment, select “UNEMPLOYED/NOT YET EMPLOYED”.
5. The “NAME EXTENSION” shall refer to JR., II, III and the like.
6. Indicate the full name of your FATHER and MOTHER as they appear in your birth certificate.
7. On the “OCCUPATION” portion, indicate your job, profession, or type of work to earn a living.
8. On the “HEIRS” portion, the provision on the Laws on Succession, under the New Civil Code,
shall be observed.
9. For any subsequent change of information, please secure and accomplish Member’s Change
of Information Form (MCIF, HQP-PFF-049) and submit to any Pag-IBIG Branch nearest you.
*OCCUPATIONAL STATUS
EMPLOYED
UNEMPLOYED/NOT YET EMPLOYED
CHECK THIS BOX IF FIRST TIME JOB SEEKER
*MEMBERSHIP CATEGORY
MANDATORY
VOLUNTARY
EMPLOYED
(PRIVATE)
SELF-EMPLOYED
EMPLOYED
(FOREIGN GOVERNMENT)
MEMBER OF COOPERATIVE/
EMPLOYED
(GOVERNMENT)
PROFESSIONAL/BUSSINESS OWNER
BARANGAY OFFICIAL/EMPLOYEE
TRADE UNION
EMPLOYED PRIVATE HOUSEHOLD
JOB ORDER PERSONNEL
NON-WORKING SPOUSE
OVERSEAS FILIPINO IMMIGRANT
OVERSEAS FILIPINO
OTHER EARNING GROUP (OEGs)
MEMBER OF RELIGIOUS GROUP
OTHERS,
Please specify
WORKER (OFW)
PENSIONER/INVESTOR/LESSOR
__________________________
PERSONAL DETAILS
NAME
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)
MEMBER’S 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
TAXPAYER 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
______ (cm)
WEIGHT
______ (kg)
PROMINENT DISTINGUISHING FACIAL FEATURES
(Ex. Moles, Scars, etc.)
COMMON REFERENCE NUMBER (CRN)
(If Available)
FREQUENCY OF MEMBERSHIP SAVINGS (MS)
PAYMENT
(If payment of MS is not thru payroll deduction)
Monthly
Semi-Annually
Quarterly
Annually
ADDRESS AND CONTACT DETAILS
*PERMANENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name
(Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NUMBER
Home
Cell Phone
Business (Direct Line)
Business (Trunk Line) Local
Email Address
Subdivision
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.
HQP-PFF-039
(V08, 11/2020)
I
hereby certify that the information given, and all statements made herein are true and correct.
Likewise, I hereby authorize Pag-IBIG Fund to collect
record, organize, update/modify, consult, use, consolidate, block, erase or destruct my personal data as part of my information. I hereby affirm my
right to: (a) be informed; (b) object to processing; (c) access; (d) rectify, suspend or withdraw my personal data; (e) damages; and (f) data portability
pursuant to the provision of R.A. No. 10173 (Data Privacy Act of 2012).
______________________________________ _________________
SIGNATURE OF INFORMANT
DATE
CERTIFICATION
FOR Pag-IBIG FUND USE ONLY
RECEIVED BY
_________________________________
Signature over Printed Name
________________________
Designation/Position
____________________
Branch/Unit
DATE
PRESENT EMPLOYMENT DETAILS
(If with more than one (1) employer, use separate sheet and follow format below)
*OCCUPATION
EMPLOYMENT STATUS
TYPE OF WORK
(For OFW only)
(Pls. specify country of assignment)
Land-based
__________________________
Sea-based
__________________________
Permanent/Regular
Casual
Contractual
Project-based
Part-time/
Temporary
*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
OFFICE ASSIGNMENT
Head Office
Branch ____________
Municipality/City Province
State/Country (If abroad)
ZIP Code
DATE EMPLOYED
(Month, Year)
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
TO
m m y y y y
m m y y y y
EMPLOYER/BUSINESS NAME
OFFICE ASSIGNMENT
Head Office
Branch ____________
EMPLOYER/BUSINESS ADDRESS
FROM
TO
m m y y y y
m m y y y y
EMPLOYER/BUSINESS NAME
OFFICE ASSIGNMENT
Head Office
Branch ____________
EMPLOYER/BUSINESS ADDRESS
FROM
TO
m m y y y y
m m y y y y
HEIRS
(In case of death, Fund benefits shall be divided among the member’s heirs in accordance with the Rules of Succession under the New Civil Code, as amended) (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
DISCLAIMER
Membership registration with the Fund does not automatically qualify a Pag-IBIG member to avail of the Fund’s 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.
HQP-PFF-039
(V08, 11/2020)