HQP-PFF-039

(V10,
04/2023)

MEMBER’S DATA FORM

FOR Pag-IBIG Fund USE ONLY
Pag-IBIG MID NO.

(MDF) REGISTRATION TRACKING NO.

INSTRUCTIONS
1. Accomplish this form in one (1) copy only. If registration is thru online, the 6. The “NAME EXTENSION” shall refer to JR., II, III and the like.
form should be printed back to back on a single sheet of paper. 7. Indicate the full name of your FATHER and MOTHER as they appear in your birth certificate.
2. Submit photocopy of at least one (1) valid ID acceptable to the Fund. 8. On the “OCCUPATION” portion, indicate your job, profession, or type of work to earn a living.
3. Type or print all entries in BLOCK or CAPITAL LETTERS. 9. On the “HEIRS” portion, the provision on the Laws on Succession, under the New Civil
4. All fields marked with asterisk (*) are mandatory. Code, shall be observed.
5. On the “OCCUPATIONAL STATUS” portion, if not employed or purpose is 10.For any subsequent change of information, please secure and accomplish Member’s Change
pre- employment, select “UNEMPLOYED/NOT YET EMPLOYED” . For first of Information Form (MCIF, HQP-PFF-049) and submit to any Pag-IBIG Branch nearest you.
time jobseekers, select also the “CHECK THIS BOX IF FIRST TIME
JOBSEEKERS” .

*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 EMPLOYEE OF FOREIGN MEMBER OF COOPERATIVE
GOVERNMENT OWNER JOB ORDER PERSONNEL GOVERNMENT MEMBER OF TRADE UNION
PRIVATE HOUSEHOLD OTHER EARNING GROUP (OEGs) BARANGAY NON-WORKING SPOUSE
OVERSEAS FILIPINO Please specify: OFFICIAL/EMPLOYEE OTHERS, MEMBER OF RELIGIOUS
WORKER (OFW) OTHERS, Please specify Please specify GROUP OVERSEAS FILIPINO
IMMIGRANT
PENSIONER/INVESTOR/LESSOR
PERSONAL DETAILS
NAME EXTENSION MIDDLE NAME NO MIDDLE NAME
NAME LAST NAME FIRST 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 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

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 MAYBE REPRODUCED. NOT FOR SALE.
 HQP-PFF-039
(V10, 04/2023)

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-
Casual Project- time/ Land-based
based Temporary 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 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 overPrinted 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 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

1 Pag-IBIG MID No. - a unique 12-digit number

series assigned to a registered member. To be Mandatory Coverage
accomplished by Pag-IBIG Fund.
a. Employed
2 Registration Tracking No. (RTN) - refers to system-
generated number issued after completion of online Private - any person in service of a private
registration. employer and who receives compensation for
such services rendered, mayor may not be
3 Instructions - refers to quick guide in accomplishing the registered yet with the Social Security System
MDF. (SSS); will also include the following:
- Employees of foreign-based employers with
4 Occupational Status - check the appropriate box to an administrative agreement with the Fund
indicate working status of a person either employed,
unemployed or not yet employed (for first time Government - any person in service of any of
jobseeker). the government offices that are coverable by the
GSIS; will also include the following:
5 Membership Category - check the appropriate box to - Uniformed personnel of the Armed Forces of the
indicate type of membership coverage as defined under
Philippines, Philippine National Police, Bureau
R.A. 9679.
of Fire Protection, Bureau of Jail Management
and Penology
- Members of the Judiciary and Constitutional
Commissions
 Private Household – any individual Voluntary Coverage
rendering domestic services exclusively to a
household; may include the following: a . Employed
- Housemaid/Housekeeper
- Nanny
Employee of Foreign Government - refers
- Gardener to employee of foreign
- Cook
government (embassies/consulates) or
- Driver
international organizations without an
- Butler
administrative agreement with the Fund.
- Guard
- Governess
Barangay Official/Employee - refers to any
- Launderer person in authority in their jurisdictions, or who
may be designated by law or ordinance and
b. Overseas Filipino Worker (OFW) - any person charged with the maintenance of public order,
working for a foreign-based employer, protection and security of life and property, or
whether deployed or for deployment the maintenance of a desirable and balanced
abroad, or a combination of local and environment, or who comes to the aid of persons in
overseas deployment, whether based on land or authority.
at sea.
b. Individual Payor
c. Self-employed (SE) - any person not over sixty
(60) years old, who is practicing his/her Member of Cooperative - a member of an
profession, or engaged in any trade, business or autonomous and duly registered association
occupation, with monthly average income/ of persons, with a common bond of interest, who
earnings of at least P 1 , 0 0 0 and is not under have voluntarily joined together to achieve their
an employer- employee relationship. social, economic, and cultural needs and
aspirations by making equitable contributions
Professional/Business Owner - refers to to the capital required, patronizing their products
individual that earns income through conducting and services and accepting a fair share of the risks
profitable operations from a trade or business that and benefits of the undertaking in accordance
he operates directly. 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 Member of Trade Union - a member of
daily or hourly basis and has no employee- an organization whose membership consists of
employer relationship. workers and union leaders, united to protect and
promote their common interest.
Other Earning Group (OEGs) - this refers to
small scale units engaged in the production of Non-Working Spouse - refers to a spouse
goods and services with the primary objective of who devotes full time to managing the household
generating employment and income to the person and family affairs.
concerned in order to earn a living.
Member of Religious Group - refers to individual,
- Public Utility Transport Driver head or leader of any organization in the exercise
of religious belief.
- Market Vendor
- Farmer
- Fisher Folk Overseas Filipino Immigrant - refers to a person
- Others (Other similar self-employed individuals) of Filipino origin who lives out of the Philippines
as citizen or as permanent resident of a
different country.

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

Lessor - shall include the owner or administrator

or agent of the owner of the residential unit.
6 Member’s Name - this portion shall be accomplished in 22 SSS/GSIS Number - for private employees, indicate
the following order: your 10-digit Social Security Number, and for
Last Name - refers to the family name or surname.
government employees, indicate your 11-digit Business
First Name - refers to the given name.
Partner Number.
Name Extension - refers to Jr., II, III and the like.
Middle Name - refers to registrant’s mother’s
23 Employee Number - refers to your company ID number.
maiden last name or for married women, refers to For AFP/PNP Employee, indicate Serial/Badge No.
father’s last name.
For DepEd Employee, aside from Employee
No Middle Name - this portion shall be checked
Number, indicate Division Code-Station Code
if informant is not using a middle name, such as
the Chinese.
24 Permanent Home Address - indicate the address of
your permanent residence.
7 Father’s Name Please refer to item
no. 6 in
Mother’s Name (Maiden Name) accomplishing 25 Present Home Address - indicate the address where
8
Last Name, First you currently reside, and the state/country only if
Name, Name present address is outside the Philippines.
9 Spouse’ Name Extension, and Middle
Name
26 Preferred Mailing Address - check the appropriate box
10 Member’s Name as Appearing in the Birth Certificate to indicate your chosen address to receive mail.
- indicate Member’s name based on Birth Certificate.
27 Contact Numbers - indicate the country and area code
11 Date of Birth - indicate date of birth in the following only if outside Metro Manila or based abroad.
format: mm/dd/yyyy
Example: If born on January 14, 1980,please write
28 Occupation - indicate your job, profession, or type of
01 14 1980.
work to earn a living.

12 Place of Birth - indicate the City/Municipality/ For Other Working Group (OWG)/Informal Sector,
Province/Country where the registrant was born. select from the following:
Specify
only the country if born outside the Philippines. - Public Utility Transport Driver
13 - Market Vendor
Sex - check the appropriate box. - Farmer
14 - Fisher Folk
Height - indicate height in centimeters (cm). - Others (Other workers in the informal sector)
Conversion: 1 foot = 30.48 cm
1 inch = 2.54 cm 29 Employment Status - check the appropriate box.
Example: 5’3” = 160.02 cm
15 30 Employer/Business Name - indicate complete
Weight - indicate weight in kilograms (kg). Employer/Business Name appearing in the registration
Conversion: 1 pound (lb) = 0.4536 kilogram certificate or employment contract (applicable for
Example: 120 lbs = 54.43 kg Formally Employed, OFW and Self-employed
16 Professional/Business Owner).
Common Reference Number (CRN) - indicate if
available.
31 Employer/Business Address - indicate complete
17
Marital Status - check the appropriate box. Employer/Business Address appearing in the
registration certificate or employment contract
18 (applicable for Formally Employed, OFW and Self-
Citizenship - indicate your nationality.
employed Professional/Business Owner) .
19
Prominent Distinguishing Facial Features - indicate
32 Type of Work - check the appropriate box (applicable
your distinguishing features that can be found on the
for OFW only).
face such as “mole under the right eye” or “mole or birth
mark on the left cheek/forehead” .
33 Monthly Income - indicate your income or earning per
20 month.
Frequency of Membership Savings (MS) Payment -
check appropriate box if payment of MS is not thru
payroll deduction. 34 Office Assignment - check the appropriate box to
indicate whether assigned to Head Office or a particular
21 Branch.
Taxpayer Identification Number (TIN) - indicate your
9-digit TIN issued by the Bureau of Internal Revenue
(BIR).
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.