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HQP-PFF-162 Application for Penalty Discount on Provident Obligation

Pag-Ibig application form for penalty discount on provident obligation

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APPLICATION FOR PENALTY DISCOUNT ON
PROVIDENT OBLIGATION
(For Unregistered/Delinquent Employer)
EMPLOYER/BUSINESS NAME

Pag-IBIG EMPLOYER ID No./
REGISTRATION TRACKING NUMBER

EMPLOYER/BUSINESS ADDRESS

DATE FILED

DATE OF REGISTRATION WITH CONCERNED AGENCIES (SEC/DTI/CDA)

START OF BUSINESS OPERATION

REASON FOR FAILURE TO REGISTER COVERED EMPLOYEES AND/OR REMIT THE REQUIRED
MEMBERSHIP SAVINGS

m m
d d
y
TELEPHONE NUMBER

y

y

y

WITH PREVIOUS AVAILMENT OF
PENALTY CONDONATION
YES

NO

APPLICATION AGREEMENT
I hereby certify that I have read and understood the contents hereof, including the guidelines and instructions indicated at the back portion of this form. I
further certify that all information I have indicated herein and statements declared in the payroll, remittance form and other documents submitted to the
Fund are true and correct to the best of my knowledge and belief, and that my signature appearing herein is genuine and authentic.
I shall abide with all the applicable rules and regulations governing the penalty discount and payment scheme that the Fund shall promulgate from time to
time. In case of falsification, misrepresentation or any similar acts committed by me, Pag-IBIG Fund shall automatically disapprove and/or cancel this
application. In the event of non-compliance to the guidelines governing this program, I understand that the Fund shall automatically terminate the
payment scheme and re-impose all penalties discounted, and we shall continue to incur penalties on unremitted Membership Savings and shall be held
criminally liable and prosecuted in accordance with the penal provisions of R.A. 9679, and other relevant laws.

______________________________________________
HEAD OF OFFICE/AUTHORIZED REPRESENTATIVE
(Signature over Printed Name)

________________________
Designation/Position

________________
Date

THIS PORTION IS FOR Pag-IBIG FUND USE ONLY
RECEIVED BY

REMARKS

DATE

COMPUTATION OF TOTAL PROVIDENT OBLIGATION
AMOUNT

COMPUTED BY

DATE

REVIEWED BY

DETAILS

DATE

PERIOD COVERED (From________ To__________)
TOTAL UNREMITTED MEMBERSHIP SAVINGS
DEPRIVED DIVIDENDS
TOTAL ASSESSED PENALTIES (TAP)
LESS:
INITIAL PAYMENT
(PFR No. ____________ PFR Date ___________)
APPROVED BY

TAP DISCOUNT

DATE

TOTAL
PAYMENT SCHEME

FULL PAYMENT

INSTALLMENT No. of Months____

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
(V02, 02/2017)

GUIDELINES AND INSTRUCTIONS
A. Who May File
Any unregistered/delinquent employer who satisfies the following requirements:
1. The employer must pay in full the total unremitted membership savings, deprived dividends, and a minimum of 40% of the Total Assessed
Penalties (TAP) as of payment date.
2. It must not have collected the membership savings from its employees but failed to remit the same.
3. If the employer has previously availed of a penalty condonation, it must have fully complied with the terms of said condonation.
B. How To File
The applicant shall:
1. Secure and accomplish the Application for Penalty Discount on Provident Obligation (For Unregistered/Delinquent Employer) from the Pag-IBIG
Branch. The application form may be downloaded from the Pag-IBIG Fund website at www.pagibigfund.gov.ph.
2. Submit complete application and required documents (refer to Checklist of Requirements below) to Pag-IBIG Branch maintaining your account.
C. DISCOUNT ON TOTAL ASSESSED PENALTIES (TAP)
It shall be based on the percentage of cash payment on the TAP and shall be in accordance with the schedule provided in the table below:

% of Paid Penalty to TAP

Discount Rate on TAP

60%

40%

50% - <60%

20%

40% - <50%

10%

D. PAYMENT SCHEME FOR THE BALANCE OF TAP
The balance of the penalty (i.e., less the initial payment and the discount) shall be paid in the following manner:
1. If the balance is less than P25,000.00, by full payment within seven (7) days from the date of approval of the discount.
2. If the balance is at least P25,000.00, by installment within a maximum period of twelve (12) months from the date of approval of the discount. The
first installment shall be due on the 30th day from the date of approval and the succeeding due dates every 30th day thereafter.
3. The employer shall be required to issue post-dated checks to cover the 12-month installment.
4. Should the employer fail to pay any installment as it falls due, the portion of the penalty deducted from the TAP shall be re-imposed.

CHECKLIST OF REQUIREMENTS
IMPORTANT
1. Pag-IBIG FUND RESERVES THE RIGHT TO REQUEST ADDITIONAL DOCUMENTS. THE PROCESSING OF PENALTY DISCOUNT SHALL COMMENCE ONLY
UPON SUBMISSION OF COMPLETE DOCUMENTS.
2. IN ALL INSTANCES WHEREIN PHOTOCOPIES ARE SUBMITTED, THE ORIGINAL DOCUMENT MUST BE PRESENTED FOR AUTHENTICATION.

BASIC REQUIREMENTS

ADDITIONAL REQUIREMENTS

1. Application for Penalty Discount on Provident Obligation
(HQP-PFF-162)

For Unregistered Employer

2. Submit the following:
a) Payroll for applicable period/SSS R-3 (Photocopy)
b) Pag-IBIG Fund Receipt (PFR) reflecting Required Initial
Payment details (Photocopy)
c) Remittance File (Member’s Contribution Remittance Form
(MCRF, in softcopy)
3. If filing thru Authorized Representative, submit the following:
a) For Sole Proprietorship and Partnership
- Special Power of Attorney (SPA)
b) For Corporation
- Notarized
Board
Resolution/Secretary’s
Certificate
designating the Representative to transact/negotiate with the
Fund and to execute/sign documents submitted
c) Photocopy of at least one (1) valid ID card with photo and
signature of Authorized Representative.

1. Employer’s Data Form (EDF) reflecting Pag-IBIG Employer ID
No./Registration Tracking Number (RTN)
2. Certified true copy of applicable proof of business existence:
 Business Permit/Mayor’s Permit
 Department of Trade and Industry (DTI) Certificate of Registration
(For Sole Proprietorship)
 Securities and Exchange Commission (SEC) Certificate of
Partnership/Incorporation
(For
Partnership/Corporation/ForeignOwned Corporation/Trade Association)
 Cooperative Development Authority (CDA) Certificate (For
Cooperative)
 
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