SEARCH
Philippine Government Forms All in One Location
Tweet
Share
HQP-HLF-192 Information Sheet
Pag - Ibig information sheet for accreditation of collection agency/company
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: HQP-HLF-192
ACCREDITATION INFORMATION SHEET
INSTRUCTIONS
Pag-IBIG EMPLOYER’S ID NUMBER
1. Accomplish this form in two (2) copies.
2. Type or print all entries in BLOCK and CAPITAL LETTERS.
3. Submit all required documents specified in the Checklist of Requirements (HQP-HLF-191).
NOTE: All information and documents obtained from the Collection Agencies shall be held with
STRICT CONFIDENTIALITY and for Pag-IBIG Fund use only.
REGISTRATION TRACKING NUMBER
GENERAL INFORMATION
START
OF
(mm/dd/yyyy)
BUSINESS NAME
BUSINESS ADDRESS
Unit/Room No., Floor
Subdivision
BUSINESS
OPERATION
COUNTRY + AREA CODE TELEPHONE NUMBER
Building Name
Barangay
Lot No., Blk No., Phase No., House No.
Municipality/City
LENGTH OF STAY IN BUSINESS
ADDRESS (in years)
Business (Direct Line)
Street Name
Province
Zip Code
Business (Fax)
Business (Trunk Line)
SEC/DTI REGISTRATION NO.
PHILIPPINE ASSOCIATION OF COLLECTION AGENCIES
INC. (PACAI) MEMBER?
Yes, since when? _________________
No
DATE OF ISSUANCE
TIN
DOLE REGISTRATION NO.
DATE OF ISSUANCE
Business Email Address
LEGAL PERSONALITY
Sole Proprietorship
Partnership
SSS/GSIS NO.
Corporation
Others,(pls. specify)________________
CLIENT INDUSTRY
Banking
Credit Card
Local
Cell Phone Number
Telephone Company
Others,(pls. specify)________________
PROPRIETOR/PARTNERS/STOCKHOLDERS
(Use additional sheet, if necessary)
NAME
ADDRESS
CONTACT NO/S.
CLIENT REFERENCES
(Use additional sheet, if necessary)
NAME
ADDRESS
CONTACT NO/S.
NATURE OF CONTRACT AND AMOUNT
CONTRACT PERIOD
TRACK RECORD
NAME OF CLIENT
CERTIFICATION
I certify that the foregoing information/statement is to my knowledge, true, correct, complete, and updated. The signature
appearing below is genuine. I hereby authorize Pag-IBIG Fund to conduct verification or take such other steps or measures that it
may consider appropriate to establish the correctness, validity, and authenticity of all the details stated on this document as well as
the other documents that I have submitted from whatever source.
Head of Office/Authorized Representative
Designation/Position
Date
(Signature over Printed Name)
FOR Pag-IBIG FUND USE ONLY
RECEIVED BY
.
DATE
APPROVED BY
DATE
(July 2012)
