PH Pag-IBIG HQP-PFF-039 2023-2025 free printable template

HQP-PFF-039 (V08, 11/2020) 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 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. ? EMPLOYED *OCCUPATIONAL STATUS 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. ? UNEMPLOYED/NOT YET EMPLOYED ? CHECK THIS BOX IF FIRST TIME JOB SEEKER *MEMBERSHIP CATEGORY MANDATORY VOLUNTARY ? EMPLOYED (PRIVATE) ? SELF-EMPLOYED ? EMPLOYED (GOVERNMENT) ? PROFESSIONAL/BUSSINESS OWNER ? EMPLOYED PRIVATE HOUSEHOLD ? JOB ORDER PERSONNEL ? OVERSEAS FILIPINO ? OTHER EARNING GROUP (OEGs) WORKER (OFW) ? EMPLOYED (FOREIGN GOVERNMENT) ? MEMBER OF COOPERATIVE/ ?...BARANGAY OFFICIAL/EMPLOYEE TRADE UNION ? NON-WORKING SPOUSE ? OVERSEAS FILIPINO IMMIGRANT ? MEMBER OF RELIGIOUS GROUP ? OTHERS, Please specify ? 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 *PLACE OF BIRTH (City/Municipality/Province/Country) *MARITAL STATUS ? Single/Unmarried ? Widow/er ? Annulled ? Married ? Legally Separated TAXPAYER IDENTIFICATION NUMBER (TIN) *CITIZENSHIP SSS/GSIS NUMBER (Please indicate country if born outside the Philippines) EMPLOYEE NUMBER *SEX ? Male ? Female HEIGHT WEIGHT ______ (cm) ______ (kg) PROMINENT DISTINGUISHING FACIAL FEATURES (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 (V08, 11/2020) 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 MONTHLY INCOME Basic + Allowances/Others *EMPLOYER/BUSINESS...ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. = Total Mo. Income Street Name Subdivision OFFICE ASSIGNMENT Barangay ? Head Office Municipality/City Province State/Country (If abroad) ? 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 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 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 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. ANNEX A GUIDE IN ACCOMPLISHING MEMBER’S DATA FORM (MDF) FRONT BACK Submit MDF in one (1) copy and observe...the following: ? Mandatory Coverage 1 Pag-IBIG Membership ID (MID) Number - a unique 12digit number series assigned to a registered member. To be accomplished by Pag-IBIG Fund. 2 Registration Tracking Number (RTN) - refers to system-generated number issued after completion of online registration. 3 Instructions - refers to quick guide in accomplishing the MDF. 4 Occupational Status - check the appropriate box to indicate working status of a person either employed, unemployed or not yet...employed (for first time job seeker). 5 Membership Category - check the appropriate box to indicate type of membership coverage as defined under R.A. 9679. a. Employed (Private) - any person in service of a private employer and who receives compensation for such services rendered, may or may not be registered yet with the Social Security System (SSS); will also include the following: - Employees of foreign-based employers with an administrative agreement with the Fund b. Employed (Government)...- any person in service of any of the government offices that are coverable by the GSIS; will also include the following: - Uniformed personnel of the Armed Forces of the Philippines, Philippine National Police, Bureau of Fire Protection, Bureau of Jail Management and Penology - Members of the Judiciary and Constitutional Commissions c. Overseas Filipino Worker (OFW) - any person working for a foreign-based employer, whether deployed or for deployment abroad, or a combination of local and...overseas deployment, whether based on land or at sea. e. Pensioner - any person receiving old-age or permanent total disability pension or any person who has received the lump sum excluding one receiving survivorship pension benefits; or Investor - the owner of investor securities or investor share where investor securities or shares mean shares of stock issued by a Real Estate Investment Trust (REIT) or derivatives thereof; or d. Self-employed (SE) - any person not over sixty (60) years old,...who is practicing his/her profession, or engaged in any trade, business or occupation, with monthly average income/ earnings of at least P1,000 and is not under an employer-employee relationship. Lessor - shall include the owner or administrator or agent of the owner of the residential unit. Professional/Business Owner - refers to individual that earns income through conducting profitable operations from a trade or business that he operates directly. f. Member of Cooperative - a member of...an autonomous and duly registered association of persons, with a common bond of interest, who have voluntarily joined together to achieve their social, economic, and cultural needs and aspirations by making equitable contributions to the capital required, patronizing their products and services and accepting a fair share of the risks and benefits of the undertaking in accordance with the universally accepted cooperative principles; or Job Order Personnel - refers to hired workers for a piece of...work or intermittent job of short duration not exceeding six (6) months and is paid on a daily or hourly basis and has no employee-employer relationship. Other Earning Group (OEGs) - this refers to small scale units engaged in the production of goods and services with the primary objective of generating employment and income to the person concerned in order to earn a living. - Member of Trade Union - a member of an organization whose membership consists of workers and union leaders, united to...protect and promote their common interest. Public Utility Transport Driver Market Vendor Farmer Fisher Folk Others (Other similar self-employed individuals) ? Voluntary Coverage g. Overseas Filipino Immigrant - refers to a person of Filipino origin who lives out of the Philippines as citizen or as permanent resident of a different country. 6 Member’s Name - this portion shall be accomplished in the following order: ? Last Name - refers to the family name or surname. ? First Name - refers to...the given name. ? Name Extension - refers to Jr., II, III and the like. ? Middle Name - refers to registrant’s mother’s maiden last name or for married women, refers to father’s last name. ? No Middle Name - this portion shall be checked if informant is not using a middle name, such as the Chinese. 7 Father’s Name 8 Mother’s Name (Maiden Name) 9 Spouse’ Name a. Employed (Foreign Government) - refers to employee of foreign government (embassies/consulates) or international organizations...without an administrative agreement with the Fund. b. Barangay Official/Employee - refers to any person in authority in their jurisdictions, or who may be designated by law or ordinance and charged with the maintenance of public order, protection and security of life and property, or the maintenance of a desirable and balanced environment, or who comes to the aid of persons in authority. c. Non-Working Spouse - refers to a spouse who devotes full time to managing the household and family...affairs. d. Member of Religious Group - refers to individual, head or leader of any organization in the exercise of religious belief. Please refer to item no. 6 in accomplishing Last Name, First Name, Name Extension, and Middle Name 10 Member’s Name as Appearing in the Birth Certificate - indicate Member’s name based on Birth Certificate. 11 Date of Birth - indicate date of birth in the following format: mm/dd/yyyy Example: If born on January 14, 1980, please write 01 14 1980. 12 Place...of Birth - indicate the City/Municipality/ Province/Country where the registrant was born. Specify only the country if born outside the Philippines. 13 Sex - check the appropriate box. 14 Height - indicate height in centimeters (cm). Conversion: 1 foot = 30.48 cm 1 inch = 2.54 cm Example: 5’3” = 160.02 cm 15 Weight - indicate weight in kilograms (kg). Conversion: 1 pound (lb) = 0.4536 kilogram Example: 120 lbs = 54.43 kg 16 Common Reference Number (CRN) - indicate...if available. 17 Marital Status - check the appropriate box. 18 Citizenship - indicate your nationality. 19 Prominent Distinguishing Facial Features - indicate your distinguishing features that can be found on the face such as “mole under the right eye” or “mole or birth mark on the left cheek/forehead”. 20 21 22 Frequency of Membership Savings (MS) Payment check appropriate box if payment of MS is not thru payroll deduction. Taxpayer Identification Number (TIN) - indicate your 9-digit...TIN issued by the Bureau of Internal Revenue (BIR). SSS/GSIS Number - for private employees, indicate your 10-digit Social Security Number, and for government employees, indicate your 11-digit Business Partner Number. 23 Employee Number - refers to your company ID number. ? For AFP/PNP Employee, indicate Serial/Badge No. ? For DepEd Employee, aside from Employee Number, indicate Division Code-Station Code 24 Permanent Home Address - indicate the address of your permanent...residence. 25 Present Home Address - indicate the address where you currently reside, and the state/country only if present address is outside the Philippines. 26 Preferred Mailing Address - check the appropriate box to indicate your chosen address to receive mail. 27 Contact Numbers - indicate the country and area code only if outside Metro Manila or based abroad. 28 Occupation - indicate your job, profession, or type of work to earn a living. For Other Working Group (OWG)/Informal...Sector, select from the following: - Public Utility Transport Driver Market Vendor Farmer Fisher Folk Others (Other workers in the informal sector) 29 Employment Status - check the appropriate box. 30 Employer/Business Name - indicate complete Employer/Business Name appearing in the registration certificate or employment contract (applicable for Formally Employed, OFW and Self-employed Professional/Business Owner). 31 Employer/Business Address - indicate complete Employer/Business Address...appearing in the registration certificate or employment contract (applicable for Formally Employed, OFW and Selfemployed Professional/Business Owner). 32 Type of Work - check the appropriate box (applicable for OFW only). 33 Monthly Income - indicate your income or earning per month. 34 Office Assignment - check the appropriate box to indicate whether assigned to Head Office or a particular Branch. 35 Date Employed - indicate inclusive date of employment under current...employer. 36 Previous Employment From Date of Pag-IBIG Membership - indicate details of your previous employment. 37 Heirs - indicate your legal heir/s in accordance with the Laws of Succession, as provided in the New Civil Code of the Philippines, as amended. 38 Certification - affix your signature and indicate the date when the MDF was accomplished. 39 Acknowledgement - to be accomplished by Pag-IBIG Fund.