Member'S Data Form (MDF) : Instructions
Member'S Data Form (MDF) : Instructions
(V10,
04/2023)
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” .
*MEMBER
FATHER
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
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)
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)
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).
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
FRONT
BACK
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.