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HQP-AAF-117 Co-Buyer's Information Sheet

Pag - Ibig co - buyer's information sheet for purchase of an acquired asset

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CO-BUYER’S INFORMATION SHEET

(For Purchase of Acquired Assets thru Long-Term Installment Sale)
Pag-IBIG MID NO./RTN

HL Account Number if with existing HL Account

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

CO-BUYER’S DATA
LAST NAME

FIRST NAME

CITIZENSHIP

NAME EXTENSION

DATE OF BIRTH (mm/dd/yy)

MIDDLE NAME

EE SSS/GSIS ID NO.

Building Name

Lot No., Blk No., Phase No., House No.

Subdivision

Barangay

Municipality/City

ATTACH HERE
1”X1”
ID PHOTO
OF APPLICANT

TIN

PERMANENT HOME ADDRESS
Unit/Room No., Floor

SEX
M
F

MARITAL STATUS
 Single/Unmarried
 Legally Separated
 Widow/er

Street Name

Province and State Country (if abroad)

Zip Code

 Married
 Annulled

NO. OF DEPENDENT/S

BUYER’S CONTACT DETAILS

PRESENT HOME ADDRESS
Unit/Room No., Floor

Building Name

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

Subdivision

Barangay

Municipality/City

(Indicate country code if abroad)

Street Name

COUNTRY + AREA CODE TELEPHONE NO.

Province and State Country (if abroad)

Zip Code

Home
Cell Phone

HOME OWNERSHIP
 Owned
 Company
 Mortgaged

YEARS OF STAY IN PRESENT HOME
ADDRESS

 Living w/ relatives/parents

Email Address

 Rented at P_____________/mo.

EMPLOYER/BUSINESS NAME (If self-employed)

EMPLOYER’S CONTACT DETAILS

Pag-IBIG EMPLOYER ID NO.

(Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NO.

Business (Direct Line)

EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor

Building Name

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

Subdivision

Barangay

Municipality/City

OCCUPATION

Street Name

Province and State Country (if abroad)

POSITION & DEPARTMENT

Business (Trunk Line)

Zip Code

YEARS IN EMPLOYMENT/ BUSINESS

Employer/Business Email Address

PREFERRED MAILING ADDRESS
 Present Home Address
 Employer/Business Address
 Permanent Home Address

 Employed
 Self-Employed
INDUSTRY
 Accounting
 Activities of Private Households as
Employer’s & Undifferentiated Production
Activities of Private Households
 Agriculture, Hunting, Forestry & Fishing
 Basic Materials
 Business Process Outsourcing (BPO)
 Construction

 Education & Training
 Electricity, Gas and Water Supply
 Extra-Territorial Organization & Bodies
 Financial Services/Intermediation
 HR/Recruitment
 Health and Social Work; Health and
Medical Services
 Life Sciences

 Management
 Manufacturing
 Media
 Mining and Quarrying
 Other Community, Social & Personal
Service Activities
 Public Administration & Defense;
Compulsory Social Security

 Technology
 Transport, Storage and Communications
 Travel and Leisure
 Wholesale & Retail Trade; Repair of Motor
Vehicles, Motorcycles, Personal &
Household Goods

SPOUSE’S PERSONAL DATA
LAST NAME

FIRST NAME

CITIZENSHIP

NAME EXTENSION

DATE OF BIRTH (mm/dd/yy)

MIDDLE NAME

TIN

EMPLOYER/BUSINESS NAME (If self-employed)

Pag-IBIG MID NO./RTN
OCCUPATION
 Employed

Pag-IBIG EMPLOYER ID NO.

 Self-Employed

YEARS IN EMPLOYMENT/ BUSINESS

EMPLOYER/BUSINESS ADDRESS

POSITION & DEPARTMENT

Unit/Room No., Floor

Building Name

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

Subdivision

Barangay

Municipality/City

Street Name

Province and State Country (if abroad)

Zip Code

BUSINESS TEL. NO.

INDUSTRY
 Accounting
 Activities of Private Households as
Employer’s & Undifferentiated Production
Activities of Private Households
 Agriculture, Hunting, Forestry & Fishing
 Basic Materials
 Business Process Outsourcing (BPO)
 Construction

 Education & Training
 Electricity, Gas and Water Supply
 Extra-Territorial Organization & Bodies
 Financial Services/Intermediation
 HR/Recruitment
 Health and Social Work; Health and
Medical Services
 Life Sciences

 Management
 Manufacturing
 Media
 Mining and Quarrying
 Other Community, Social & Personal
Service Activities
 Public Administration & Defense;
Compulsory Social Security

 Technology
 Transport, Storage and Communications
 Travel and Leisure
 Wholesale & Retail Trade; Repair of Motor
Vehicles, Motorcycles, Personal &
Household Goods

BANK ACCOUNTS (Indicate your 3 most active)
BANK

BRANCH/ADDRESS

TYPE OF ACCOUNT

ACCOUNT NO.

DATE OPENED

AVE. BALANCE

(V01, 02/2017)

CREDIT CARDS OWNED (Indicate your 3 most active)
CARD TYPE
(e.g. Visa/Mastercard)

ISSUER NAME

CARD EXPIRY
(mm/yyyy)

CREDIT LIMIT

REAL ESTATE OWNED
LOCATION

TYPE OF PROPERTY

ACQUISITION COST

MARKET VALUE

MORTGAGE
BALANCE

RENTAL
INCOME

OUTSTANDING CREDITS/LOAN AVAILMENTS
Creditor & Address

Security

Mo. Amortization

Type

Maturity Date

Amount/Balance

Security

Maturity Date

Amount/Balance
Creditor & Address

Mo. Amortization

Type

Security

Maturity Date

Amount/Balance
Creditor & Address

Type

Mo. Amortization

MISCELLANEOUS
(Answer

the following questions with YES or NO. If your answer is YES, please elaborate on the details as required)

Are there past or pending cases against you?  Yes
 No
If yes, please indicate the nature, plaintiff, amount involved and the status.
Do you have past due obligations?  Yes
 No
If yes, please indicate the creditor’s name, nature, amount involved and due date.
Was your bank account ever closed because of mishandling or issuance of bouncing checks?  Yes
 No
If yes, please indicate the bank’s name, nature amount and date.
Have you ever been diagnosed, treated or given medical advice by a physician or other health care provider?  Yes
If yes, please indicate the condition/diagnosis.

 No

LOAN AND CREDIT REFERENCES
BANK/FINANCIAL INSTITUTION

ADDRESS

PURPOSE

SECURITY

HIGHEST
AMOUNT
OWED

PRESENT
BALANCE

DATE
OBTAINED

DATE
FULLY PAID

TRADE REFERENCES (For Self-Employed Only)
NAME OF SUPPLIER

ADDRESS

TEL. NO.

CHARACTER REFERENCES
NAME

ADDRESS

TEL. NO.

SOURCE OF Pag-IBIG FUND HOUSING INFORMATION
 TV Ad

 Radio Ad

 Pag-IBIG Fund Personnel

 Flyer/Poster/Brochure

 Employer

 Newspaper/Magazine Ad

 Website

 Agency

 Pag-IBIG Fund Branch

 Real Estate Developer

 Seller of the Property

 Others (pls. specify) ____________

CERTIFICATION
I/We express my/our intention to purchase the Pag-IBIG Fund acquired asset as described herein and I/We further agree to purchase the property on
“as is, where is” basis.
I/We certify that the foregoing information/statement is to my/our knowledge, true, correct, complete, and updated. The signature/s appearing below
is/are genuine. I/We authorize Pag-IBIG Fund or its duly authorized representative: 1) to verify necessary information or data (i.e., certificate of employment,
pay slips and income tax return) with the concerned government agencies, any other or third parties including banks and other financial institutions from whom
Pag-IBIG Fund had obtained information; 2) to regularly submit and disclose my/our credit data (as defined under Republic Act No. 9510 and its Implementing
Rules and Regulations) to Credit Information Corporation (CIC) as well as any updates or corrections thereof; 3) to share my/our credit data with other lenders
authorized by the CIC, and credit reporting agencies duly accredited by the CIC; and 4) to send me/us updates about my/our application/account via SMS/text,
email, mail or other available means of communication.
I/We hereby further waive confidentiality rules and laws as applicable to establish correctness, validity, and authenticity of documents that would help
facilitate the processing and evaluation of my/our application.
I/We hereby agree that any misrepresentation of a material fact is a ground for disapproval of the application, cancellation of the purchase and shall be
subject to other sanctions provided in existing Pag-IBIG guidelines. I/We agree to notify Pag-IBIG Fund of any material change affecting the information
contained herein. I/We agree that all information obtained by Pag-IBIG Fund shall remain its property whether or not the application is granted.

____________________________________
SIGNATURE OF CO-BUYER

____________________________________
DATE

THIS FORM CAN BE REPRODUCED. NOT FOR SALE.
 
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