HQP-PFF-039
(V08, 11/2020)
FOR Pag-IBIG Fund USE ONLY
MEMBER’S DATA FORM Pag-IBIG MID NUMBER
(MDF) REGISTRATION TRACKING NUMBER
INSTRUCTIONS
1. Accomplish this form in one (1) copy only. If registration is thru online, the form 6. Indicate the full name of your FATHER and MOTHER as they appear in your birth certificate.
should be printed back to back on a single sheet of paper. 7. On the “OCCUPATION” portion, indicate your job, profession, or type of work to earn a living.
2. Type or print all entries in BLOCK or CAPITAL LETTERS. 8. On the “HEIRS” portion, the provision on the Laws on Succession, under the New Civil Code,
3. All fields marked with asterisk (*) are mandatory. shall be observed.
4. On the “OCCUPATIONAL STATUS” portion, if not employed or purpose is 9. For any subsequent change of information, please secure and accomplish Member’s Change
pre-employment, select “UNEMPLOYED/NOT YET EMPLOYED”. of Information Form (MCIF, HQP-PFF-049) and submit to any Pag-IBIG Branch nearest you.
5. The “NAME EXTENSION” shall refer to JR., II, III and the like.
*OCCUPATIONAL STATUS EMPLOYED UNEMPLOYED/NOT YET EMPLOYED
CHECK THIS BOX IF FIRST TIME JOB SEEKER
*MEMBERSHIP CATEGORY
MANDATORY VOLUNTARY
EMPLOYED (PRIVATE) SELF-EMPLOYED EMPLOYED (FOREIGN GOVERNMENT) MEMBER OF COOPERATIVE/
EMPLOYED (GOVERNMENT) PROFESSIONAL/BUSSINESS OWNER BARANGAY OFFICIAL/EMPLOYEE TRADE UNION
EMPLOYED PRIVATE HOUSEHOLD JOB ORDER PERSONNEL NON-WORKING SPOUSE OVERSEAS FILIPINO IMMIGRANT
OVERSEAS FILIPINO OTHER EARNING GROUP (OEGs) MEMBER OF RELIGIOUS GROUP OTHERS, Please specify
WORKER (OFW) PENSIONER/INVESTOR/LESSOR __________________________
PERSONAL DETAILS
NAME NAME EXTENSION NO MIDDLE NAME
LAST NAME FIRST NAME MIDDLE NAME
(e.g. Jr., II) (check if applicable only)
*MEMBER
FATHER
*MOTHER (Maiden Name)
*SPOUSE (If Married)
MEMBER’S NAME AS APPEARING IN
THE BIRTH CERTIFICATE
*DATE OF BIRTH *MARITAL STATUS TAXPAYER IDENTIFICATION NUMBER (TIN)
Single/Unmarried Widow/er Annulled
m m d d y y y y Married Legally Separated
*PLACE OF BIRTH (City/Municipality/Province/Country) *CITIZENSHIP SSS/GSIS NUMBER
(Please indicate country if born outside the Philippines)
EMPLOYEE NUMBER
*SEX HEIGHT WEIGHT PROMINENT DISTINGUISHING FACIAL FEATURES
Male (Ex. Moles, Scars, etc.)
Female ______ (cm) ______ (kg) For AFP/PNP Employee, Serial/Badge No.
COMMON REFERENCE NUMBER (CRN) FREQUENCY OF MEMBERSHIP SAVINGS (MS)
(If Available) PAYMENT (If payment of MS is not thru payroll deduction) For DepEd Employee, Division Code-Station Code
Monthly Semi-Annually
Quarterly Annually
ADDRESS AND CONTACT DETAILS
*PERMANENT HOME ADDRESS (Indicate country code if abroad)
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name COUNTRY + AREA CODE TELEPHONE NUMBER
Home
Subdivision Barangay Municipality/City 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 Street Name Business (Direct Line)
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code Business (Trunk Line) Local
Email Address
*PREFERRED MAILING ADDRESS
Present Home Address Permanent Home Address Employer/Business Address
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
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 TYPE OF WORK (For OFW only)
(Pls. specify country of assignment)
Permanent/Regular Contractual Part-time/
Casual Project-based Temporary
Land-based __________________________
Sea-based __________________________
*EMPLOYER/BUSINESS NAME MONTHLY INCOME
Basic
+
*EMPLOYER/BUSINESS ADDRESS Allowances/Others
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. =
Total Mo. Income
Street Name Subdivision Barangay OFFICE ASSIGNMENT
Head Office Branch ____________
Municipality/City Province State/Country (If abroad) ZIP Code DATE EMPLOYED (Month, Year)
PREVIOUS EMPLOYMENT FROM DATE OF Pag-IBIG Fund MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS FROM TO
m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS FROM TO
m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS FROM TO
m m y 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)
NAME NO MIDDLE NAME
LAST NAME FIRST NAME MIDDLE NAME RELATIONSHIP DATE OF BIRTH
EXTENSION (Check only if applicable)
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
CERTIFICATION
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 DATE
_________________________________ ________________________ ____________________
Signature over Printed Name 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.
