HQP-PFF-039
(V11,
09/2024)
MEMBER’S DATA FORM FOR Pag-IBIG Fund USE ONLY
Pag-IBIG MID NO.
(MDF) REGISTRATION TRACKING
INSTRUCTIONS NO.
1. Accomplish this form in one (1) copy only. The form should be printed back-to-back on a 7. Indicate the full name of your FATHER and MOTHER as they appear in your birth certificate.
single sheet of paper. 8. On the “OCCUPATION” portion, indicate your job, profession, or type of work to earn a living.
2. Present one (1) valid ID acceptable to the Fund and proof of income except for not yet 9. On the “HEIRS” portion, the provision on the Laws on Succession, under the New Civil Code, shall be
employed individuals or first time jobseekers. observed.
3. Type or print all entries in BLOCK or CAPITAL LETTERS. 10. If registered as foundling, the following shall be observed:
4. All fields marked with asterisk (*) are mandatory. - The name of Finder shall be indicated under the “MOTHER” or “FATHER” portion, as applicable.
5. On the “OCCUPATIONAL STATUS” portion, if not employed or purpose is pre-employment, - In case the “DATE OF BIRTH” is not available, the information under “Date When Found” shall be
select “UNEMPLOYED/NOT YET EMPLOYED”. For first time jobseekers, select also the “CHECK indicated.
THIS BOX IF FIRST TIME JOBSEEKERS”. - If the “PLACE OF BIRTH” is not available, the information under “Place Where Found” shall be indicated.
6. The “NAME EXTENSION” shall refer to JR., II, III and the like. 11. For any subsequent change of information, please secure and accomplish Member’s Change of
Information Form (MCIF, HQP-PFF-049), ang submit to any Pag-IBIG Branch nearest you.
*OCCUPATIONAL STATUS EMPLOYED UNEMPLOYED/NOT YET EMPLOYED
CHECK THIS BOX IF FIRST TIME JOBSEEKERS
*MEMBERSHIP CATEGORY
MANDATORY VOLUNTARY
EMPLOYED SELF-EMPLOYED EMPLOYED INDIVIDUAL PAYOR
PRIVATE PROFESSIONAL/BUSINESS OWNER EMPLOYEE OF FOREIGN GOVERNMENT MEMBER OF COOPERATIVE
GOVERNMENT JOB ORDER PERSONNEL BARANGAY OFFICIAL/EMPLOYEE MEMBER OF TRADE UNION
PRIVATE HOUSEHOLD OTHER EARNING GROUP (OEGs) OTHERS, please specify: NON-WORKING SPOUSE
OVERSEAS FILIPINO WORKER Please specify: MEMBER OF RELIGIOUS GROUP
(OFW) OTHERS, please specify: OVERSEAS FILIPINO IMMIGRANT
PENSIONER/INVESTOR/LESSOR
PERSONAL DETAILS
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME NO MIDDLE NAME
NAME
(e.g., Jr., II) (Check if applicable only)
*MEMBER
FATHER
*MOTHER’S MAIDEN NAME
(AS IT APPEARS ON THE
BIRTH CERTIFICATE)
*SPOUSE
(For women, indicate Maiden Name)
MEMBER’S NAME (AS IT APPEARS ON
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
(Ex. Moles, Scars, etc.)
Male
Female For AFP/PNP Employee, Serial/Badge No.
(cm) (kg)
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 Quarterly
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 Business (Direct
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name
Line)
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
Business (Trunk Line) Local
*PREFERRED MAILING ADDRESS
Present Home Address Permanent Home Address Employer/Business Address
Email Address
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
HQP-PFF-039
(V11,
09/2024)
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 COMPENSATION
Basic
+
Allowances/Others
*EMPLOYER/BUSINESS ADDRESS =
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House Total Mo. Income
No.
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 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
LAST NAME FIRST NAME EXTENSION MIDDLE NAME NO MIDDLE NAME RELATIONSHIP DATE OF BIRTH
(Check only if applicable)
m m d y y y y
m m d y y y y
m m d y y y y
FOR Pag-IBIG FUND USE ONLY
CERTIFICATION
IPROCESSED
hereby certify BY
that the information given, and all statements made herein are true and correct. Likewise, I hereby authorized Pag-IBIG Fund to DATE
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
Signature over Printed Name
Act of 2012). Designation/Position Branch/Unit
I allow Pag-IBIG Fund to send me any updates, promotions, marketing, or programs offered by the Fund through my registered cell phone number and/or email address.
SIGNATURE OF INFORMANT DATE
DISCLAIMER
Membership registration with the Fund does not automatically qualify a Pag-IBIG member to avail of the Fund’s various programs. A Pag-IBIG member must satisfy the
eligibility requirements and comply with the documentary requirements, which is subject to verification and approval.