HQP-PFF-039

(V08, 11/2020)
FOR Pag-IBIG Fund USE ONLY

MEMBER’S DATA FORM (MDF) Pag-IBIG MID NUMBER

REGISTRATION TRACKING NUMBER922043231271

INSTRUCTIONS
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.
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,
All fields marked with asterisk (*) are mandatory.shall be observed.
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.
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 EXTENSION NO MIDDLE NAME
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.
work to earn a living.