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HQP-PFF-114 Membership Savings Remittance Form

Pag-Ibig remittance form for Membership savings (Kasambahay, MSRF)

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: HQP-PFF-039
(V07, 10/2017)
FOR Pag-IBIG Fund USE ONLY

MEMBER’S DATA FORM
(MDF)

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 one 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 without employment or purpose
is pre-employment or never been employed, 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, as provided in the New
Civil Code of the Philippines, as amended by the New Family 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.

 EMPLOYED

*OCCUPATIONAL STATUS

 UNEMPLOYED/NOT YET EMPLOYED

*MEMBERSHIP CATEGORY
MANDATORY

VOLUNTARY

 EMPLOYED PRIVATE
 EMPLOYED GOVERNMENT
 OVERSEAS FILIPINO
WORKER (OFW)

 SELF-EMPLOYED (SE)
 PROFESSIONAL/BUSINESS OWNER
 JOB ORDER PERSONNEL
 OTHER EARNING GROUPS (OEGs)

 EMPLOYED FOREIGN GOVERNMENT
 BARANGAY OFFICIAL/EMPLOYEE
 NON-WORKING SPOUSE
 MEMBER OF RELIGIOUS GROUP
 PENSIONER/INVESTOR/LESSOR

 MEMBER OF COOPERATIVE/
TRADE UNION
 OVERSEAS FILIPINO IMMIGRANT
 OTHERS, Please specify
____________________________

PERSONAL DETAILS
NAME

FIRST NAME

LAST 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

*MARITAL STATUS
 Single/Unmarried  Widow/er  Annulled
 Married
 Legally Separated

y

*PLACE OF BIRTH (City/Municipality/Province/Country)

TAXPAYER IDENTIFICATION NUMBER (TIN)

*CITIZENSHIP

SSS/GSIS NUMBER

(Please indicate country if born outside the Philippines)

EMPLOYEE NUMBER
*SEX
 Male
 Female

HEIGHT

WEIGHT

______ (cm)

PROMINENT DISTINGUISHING FACIAL FEATURES

______ (kg)

(Ex. Moles, Scars, etc.)

COMMON REFERENCE NUMBER (CRN)
(If Available)

For AFP/PNP Employee, Serial/Badge No.

FREQUENCY OF MEMBERSHIP SAVINGS (MS)
PAYMENT (If payment of MS is not thru payroll deduction)
 Monthly
 Semi-Annually
 Quarterly
 Annually

For DepEd Employee, Division Code-Station Code

ADDRESS AND CONTACT DETAILS
(Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NUMBER

*PERMANENT HOME ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No. House No

Subdivision

Barangay

Municipality/City

Street Name

Home
Province/State/Country (if abroad)

ZIP Code

Cell Phone
*PRESENT HOME ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No. House No

Subdivision

Barangay

Municipality/City

*PREFERRED MAILING ADDRESS
 Present Home Address  Permanent Home Address

Business (Direct Line)

Street Name

Province/State/Country (if abroad)

ZIP Code

Business (Trunk Line)
Email Address

 Employer/Business Address

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

Local

HQP-PFF-039
(V07, 10/2017)

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

EMPLOYMENT STATUS
 Permanent/Regular
 Casual

TYPE OF WORK (For OFW only)

 Contractual
 Project-based

(Pls. specify country of assignment)

 Part-time/
Temporary

 Land-based __________________________
 Sea-based __________________________

*EMPLOYER/BUSINESS NAME (For Formally Employed, OFW and Self-employed Professional/Business Owner)

MONTHLY INCOME
Basic
+

Allowances/Others

*EMPLOYER/BUSINESS ADDRESS (For Formally Employed, OFW and Self-employed Professional/Business Owner)
Unit/Room No., Floor

Building Name

=

Lot No., Block No., Phase No. House No.

Total Mo. Income
OFFICE ASSIGNMENT

Street Name

Subdivision

Barangay

Municipality/City

Province

State/Country (If abroad)

 Head Office

 Branch ____________

DATE EMPLOYED (Month, Year)

ZIP Code

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

OFFICE ASSIGNMENT

 Head Office

 Branch ____________

FROM

EMPLOYER/BUSINESS ADDRESS
m m

EMPLOYER/BUSINESS NAME

y

TO
y

y

y

m m

y

y

y

y

OFFICE ASSIGNMENT

 Head Office

 Branch ____________

FROM

EMPLOYER/BUSINESS ADDRESS
m m

EMPLOYER/BUSINESS NAME

y

TO
y

y

y

m m

y

y

y

y

OFFICE ASSIGNMENT

 Head Office
EMPLOYER/BUSINESS ADDRESS

 Branch ____________

FROM

m m

y

TO

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 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

y

y

y

y

m

d

d

y

y

y

y

m

d

d

y

y

y

y

m



d

m



d

m



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

FOR Pag-IBIG FUND USE ONLY
RECEIVED BY
_________________________________
Signature over Printed Name

DATE
________________________
Designation/Position

____________________
Branch/Unit

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.
 
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