HQPPFF049

MEMBER'S CHANGE OF INFORMATION FORM (MeIF)

INSTRUCTIONS
1. 2. 3. 4. Accomplish this form in one (1) copy. Accomplish the applicable portions to be changed only. Type or print all entries in BLOCK/CAPITAL LETTERS. This form shall be submitted to any of the following: a) Thru Employer, if employed b) Thru on-line c) Thru Pag-IBIG NCR/Regional branch.

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REQUIREMENTS

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1. For change of name and/or marital status because of marriage, submit photocopy of Marriage Contract with registry number. 2. For correction/change of name and/or marital status for reason other than marriage, submit certified true copy of Birth Certificate issued by the National Statistics Office (NSO), Court Order or Death Certificate of the deceased spouse, whichever is applicable. 3. For correction of date of birth, submit certified true copy of Birth Certificate issued by the National Statistics Office (NSO). 4. For updating of beneficiaries, submit certified true copy of Birth Certificate of the additional beneficiary/ies issued by the National Statistics Office (NSO) to establish relationship with the member.

CHECK

APPROPRIATE

BOX ONLY OF NAME OF DATE OF BIRTH FIRST NAME

1. CORRECTION 2. CORRECTION

3. CHANGE 4. CHANGE

OF MARITAL

STATUS OF MC PAYMENT

OF FREQUENCY

5. UPDATING 6. CHANGE NAME

OF HEIRS OF ADDRESS/CONTACT DETAILS

LAST NAME

NAME EXTENSION

(e.g., jr., /I, etc.)

MIDDLE

NO MIDDLE NAME (Check if applicab/e only)

RELATIONSHIP

o
o

o
o

o o

o
Lot No., Block No., Phase No. House No Street Name Subdivision

(Indicate country code if abroad) COUNTRY+AREA CODE TELEPHONE NUMBER Home Cell phone

~------------------~------~~------------------------~~~--,
Barangay

Municipality/City

Province/State/Country

(if abroad)

ZIP Code

~I __

PERMANENT HOME ADDRESS Unit/Room No., Floor Building Name

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

Street Name

Subdivision

I I Business (Direc;-:t..:L-=in..:e!....) I I ~I

_
Local

I
Barangay Municipality/City Province/State/Country (if abroad) ZIP Code

Business (Trunkline)

'Ir---'-----' 1 __

Email Address

DOCUMENTS

SUBMITTED Contract

o
D

Birth Certificate Marriage Death Certificate

D D

Court Order Others (P/ease specify)

THIS FORM MA Y BE REPRODUCED.

NOT FOR SALE.

(Revised

08/2012)

PRESEN"T EMPLOYMEc~TpETAl LS
*EMPLOYER/BUSINESS NAME

'-

(If with more than one (1) employer, use separate sheet and follow format'below)

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'-"

-:
INCOME
+

MONTHLY Basic

*EMPLOYER/BUSINESS Unit/Room No" Floor

ADDRESS Building Name

Allowances/Others Lot No., Block No., Phase No. House No. Tota/ Mo. Income

Street Name

Subdivision

Barangay

*TYPE OF WORK (For OFWs only) OLand-based 0 Sea-based

Municipality/City

Province

State/Country (If abroad)

ZIP Code

OFFICE ASSIGNMENT

o
*OCCUPATION *EMPLOYMENT STATUS
0 Contractual 0 Project-based

Head Office

Branch TO

o Permanent/Regular o Casual
o
'PREVIOUS EMPLOYM.ENT

Pari-timelTemporary , ~-FROM DATE ~F HDMF MEMBERSHIR (Use anothe~sj;eelif necessary)

ITIIJIIJ ITIIJIIJ
m m
y y y y

*FROM

m m

EMPLOYER/BUSINESS

NAME

OFFICE ASSIGNMENT

o Head
EMPLOYER/BUSINESS ADDRESS FROM

Office

Branch

TO
yyyy

ITIIIIIJ ITIIJIIJ
mm mm
yyyy

EMPLOYER/BUSINESS

NAME

OFFICE ASSIGNMENT

o Head
EMPLOYER/BUSINESS ADDRESS FROM

Office

o Branch
TO

OIIJIIJ OIIJIIJ
mm vvvv mm vvvv
OFFICE ASSIGNMENT

EMPLOYER/BUSINESS

NAME

o Head
EMPLOYER/BUSINESS ADDRESS FROM

Office

o Branch
TO

DIIIIIJ ITIIJIIJ
mm yyyy
.;
-

H EI ~S

."

(In case of death, Fund benefits shall be divided emonq

the member's

legal heirs in accordance

wifb

the New Civil Code.

as amended

by the New Family Code)

(Use another sheet if necessary)

DATE OF BIRTH

mm

vvvv

LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE

NAME

NO MIDDLE NAME (Check only if applicable)

RELATIONSHIP

0 0 0 0

I I I m m I I I
m m

I I I I I I I d v v v v I I I I I I I
d

I m I mI
I m I mI

I I I v I v Iv I y I
d

I I I I I I I
d Y Y V V

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

SIGNATURE

OF MEMBER

DATE

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.