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    Member'S Data Form (MDF) : HQP-PFF-039

    Uploaded by

    Leilani Daguio Marcelino-Recosar
    1) The document is a member's data form (MDF) for Pag-IBIG Fund, a Philippine government run savings fund, that collects personal and employment information. 2) The form collects information such as the member's name, date of birth, address, citizenship, occupation, employer details, income, and designated heirs. 3) The form provides instructions on completing the form, including using block letters, indicating mandatory fields with asterisks, and providing additional employment history or heirs on separate sheets if needed.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Member'S Data Form (MDF) : HQP-PFF-039

    Uploaded by

    Leilani Daguio Marcelino-Recosar
    41 views2 pages
    1) The document is a member's data form (MDF) for Pag-IBIG Fund, a Philippine government run savings fund, that collects personal and employment information. 2) The form collects information such as the member's name, date of birth, address, citizenship, occupation, employer details, income, and designated heirs. 3) The form provides instructions on completing the form, including using block letters, indicating mandatory fields with asterisks, and providing additional employment history or heirs on separate sheets if needed.

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    Original Title

    Angel Bernie

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    1) The document is a member's data form (MDF) for Pag-IBIG Fund, a Philippine government run savings fund, that collects personal and employment information. 2) The form collects information such as the member's name, date of birth, address, citizenship, occupation, employer details, income, and designated heirs. 3) The form provides instructions on completing the form, including using block letters, indicating mandatory fields with asterisks, and providing additional employment history or heirs on separate sheets if needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    41 views2 pages

    Member'S Data Form (MDF) : HQP-PFF-039

    Uploaded by

    Leilani Daguio Marcelino-Recosar
    1) The document is a member's data form (MDF) for Pag-IBIG Fund, a Philippine government run savings fund, that collects personal and employment information. 2) The form collects information such as the member's name, date of birth, address, citizenship, occupation, employer details, income, and designated heirs. 3) The form provides instructions on completing the form, including using block letters, indicating mandatory fields with asterisks, and providing additional employment history or heirs on separate sheets if needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    HQP-PFF-039

    FOR Pag-IBIG Fund USE ONLY

    MEMBERS DATA
    FORM (MDF)

    Pag-IBIG MID NUMBER


    REGISTRATION TRACKING NUMBER

    916284253068

    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 which are marked with asterisk (*) are mandatory.
    4. On the OCCUPATIONAL STATUS portion, if without employment or purpose
    is pre-employment or never been employed, select UNEMPLOYED/NOT YET
    EMPLOYED.
    5. The NAME EXTENSION shall refer to JR., II, III and the like.
    6. Indicate the full name of your FATHER and MOTHER as they appear in your
    birth certificate.

    *OCCUPATIONAL STATUS

    EMPLOYED

    7. On the OCCUPATION portion, indicate occupation based on the List of


    Occupation, as provided in the Philippine Standard Occupational Classification
    (PSOC).
    8. On the HEIRS portion, the provision on the Laws on Succession, as provided
    in the New Civil Code of the Philippines, as amended by the New Family Code,
    shall be observed.
    9. For any subsequent change of information, please secure and accomplish
    Members Change of Information Form (MCIF, HQP-PFF-049) and submit to
    the concerned Pag-IBIG Branch.
    UNEMPLOYED/ NOT YET EMPLOYED

    *MEMBERSHIP CATEGORY

    MANDATORY
    EMPLOYED PRIVATE

    EMPLOYED GOVERNMENT

    OVERSEAS FILIPINO WORKER (OFW)

    SELF-EMPLOYED (SE)

    PENSIONER/INVESTOR/LESSOR

    OTHERS
    Please specify ________________

    VOLUNTARY
    EMPLOYED
    EMPLOYED FOREIGN GOVERNMENT
    BARANGAY OFFICIAL/EMPLOYEE

    INDIVIDUAL PAYOR (IP)


    NON-WORKING SPOUSE

    MEMBER OF RELIGIOUS GROUP

    MEMBER OF COOPERATIVE/TRADE UNION

    NAME
    EXTENSION

    FIRST NAME

    LAST NAME

    (e.g. Jr., II)

    MIDDLE NAME

    *MEMBER

    ANGEL

    BERNIE

    QUINQUE

    FATHER

    ANGEL

    BERNARD

    GUZMAN

    QUINQUE

    LANIE

    GUILLERMO

    ANGEL

    BERNIE

    QUINQUE

    *MOTHER (Maiden Name)

    NO MIDDLE NAME

    (check if applicable only)

    *SPOUSE (If Married)


    MEMBERS NAME AS
    APPEARING IN THE BIRTH
    CERTIFICATE

    *DATE OF BIRTH
    0

    *MARITAL STATUS
    1

    Single/Unmarried
    Married

    mm dd yyyy

    Widow/er
    Legally Separated

    Annulled

    TAXPAYER IDENTIFICATION NUMBER (TIN)


    SSS/GSIS NUMBER

    *PLACE OF BIRTH (City/Municipality/Province/Country) *CITIZENSHIP


    (Please indicate country if born outside the Philippines)

    FILIPINO

    BACNOTAN, LA UNION
    HEIGHT
    WEIGHT
    *SEX
    Male
    164 (cm)
    65 (kg)
    ______
    ______
    Female
    COMMON REFERENCE NUMBER (CRN)
    (If Available)

    PROMINENT DISTINGUISHING FACIAL FEATURES

    EMPLOYEE NUMBER

    (Ex. Moles, Scars, etc.)

    FREQUENCY OF MEMBERSHIP SAVINGS (MS)


    PAYMENT (If payment of MS is not thru payroll deduction)
    Monthly
    Quarterly

    Semi-Annually
    Annually

    For AFP/PNP Employee, Serial/Badge No.


    For DepEd Employee, Division Code-Station Code

    ADDRESS AND CONTACT DETAILS


    *PERMANENT HOME ADDRESS
    Unit/Room No., Floor

    Building Name

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

    Barangay

    Municipality/City

    Province/State/Country(if abroad)

    PURA

    *PRESENT HOME ADDRESS


    Unit/Room No., Floor

    Building Name

    Barangay

    Municipality/City
    PURA

    Street Name

    Subdivision

    2312
    Street Name

    Province/State/Country(if abroad)

    Subdivision
    ZIP Code

    2312

    TARLAC

    *PREFERRED MAILING ADDRESS


    Present Home Address

    Home

    ZIP Code

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

    (Indicate country code if abroad)


    COUNTRY + AREA CODE TELEPHONE NUMBER

    Cell Phone
    0915

    9019222

    Business (Direct Line)


    Business (Trunk Line)

    Local

    Email Address

    Permanent Home Address

    Employer/Business Address

    THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

    angelbernie70@yahoo.com
    (Rev. 03.1, 01/2015)

    PRESENT EMPLOYMENT DETAILS (If with more than one (1) employer, use separate sheet and follow format below)
    *EMPLOYER/BUSINESS NAME

    MONTHLY INCOME
    Basic

    BERNIE Q ANGEL

    Allowances/Others

    *EMPLOYER/BUSINESS ADDRESS
    Unit/Room No., Floor

    Building Name

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

    Street Name

    Subdivision

    Barangay

    Total Mo. Income

    Province

    PURA

    *State/Country (If abroad)

    TARLAC

    *OCCUPATION

    AIRCRAFT CARGO HANDLING


    SUPERVISORS

    *EMPLOYMENT STATUS
    Permanent/Regular
    Casual

    0.00

    1,100.00

    *TYPE OF WORK (For OFWs only)


    CADANGLAAN

    Municipality/City

    1,100.00

    Contractual
    Project-based

    Land-based (Pls. specify country of assignment)


    _____________________________
    Sea-based (Pls. specify manning agency)
    MINERVA MARINE INC
    _____________________________
    OFFICE ASSIGNMENT

    ZIP Code

    2312

    Branch ____________

    Head Office

    *DATE EMPLOYED (Month, Year)

    Part-time/Temporary

    October 2012

    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

    EMPLOYER/BUSINESS NAME

    OFFICE ASSIGNMENT

    EMPLOYER/BUSINESS ADDRESS

    FROM

    EMPLOYER/BUSINESS NAME

    OFFICE ASSIGNMENT

    TO
    y

    Head Office

    Branch ____________

    Branch ____________
    TO

    FROM
    m

    TO

    Head Office
    EMPLOYER/BUSINESS ADDRESS

    HEIRS (In case of death, Fund benefits shall be divided among the members heirs in accordance with the New Civil Code as amended by the New Family Code) (Use another sheet if necessary)
    LAST NAME

    FIRST NAME

    NAME
    EXTENSION

    MIDDLE NAME

    NO MIDDLE NAME

    (Check only if applicable)

    RELATIONSHIP

    DATE OF BIRTH

    I HEREBY CERTIFY THAT THE INFORMATION GIVEN AND ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT.

    _________________________________

    10/10/2016

    _________________

    SIGNATURE OF MEMBER

    DATE

    FOR Pag-IBIG FUND USE ONLY


    RECEIVED BY

    DATE

    DISCLAIMER: Membership registration with the Fund does not automatically qualify a Pag-IBIG member to avail of the Funds 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.

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