Académique Documents
Professionnel Documents
Culture Documents
(V06, 04/2017)
INSTRUCTIONS
1. 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
should be printed back to back on one single sheet of paper. certificate.
2. Type or print all entries in BLOCK or CAPITAL LETTERS. 7. On the “OCCUPATION” portion, indicate your job, profession, or type of work to earn a
3. All fields marked with asterisk (*) are mandatory. living.
4. On the “OCCUPATIONAL STATUS” portion, if without employment or purpose 8. On the “HEIRS” portion, the provision on the Laws on Succession, as provided in the New
is pre-employment or never been employed, select “UNEMPLOYED/NOT YET Civil Code of the Philippines, as amended by the New Family Code, shall be observed.
EMPLOYED”. 9. For any subsequent change of information, please secure and accomplish Member’s
5. The “NAME EXTENSION” shall refer to JR., II, III and the like. Change of Information Form (MCIF, HQP-PFF-049) and submit to any Pag-IBIG Branch
nearest you.
*MEMBERSHIP CATEGORY
MANDATORY VOLUNTARY
EMPLOYED PRIVATE SELF-EMPLOYED (SE) EMPLOYED FOREIGN GOVERNMENT MEMBER OF COOPERATIVE/
EMPLOYED GOVERNMENT PROFESSIONAL/BUSINESS OWNER BARANGAY OFFICIAL/EMPLOYEE TRADE UNION
OVERSEAS FILIPINO JOB ORDER PERSONNEL NON-WORKING SPOUSE OVERSEAS FILIPINO IMMIGRANT
WORKER (OFW) OTHER WORKING GROUP (OWG)/ MEMBER OF RELIGIOUS GROUP OTHERS, Please specify
INFORMAL SECTOR 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
EMPLOYEE NUMBER
*SEX HEIGHT WEIGHT PROMINENT DISTINGUISHING FACIAL FEATURES
Male (Ex. Moles, Scars, etc.)
Female ______ (cm) ______ (kg) For AFP/PNP Employee, Serial/Badge No.
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.
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 (For Formally Employed, OFW and Self-employed Professional/Business Owner) MONTHLY INCOME
Basic
+
*EMPLOYER/BUSINESS ADDRESS (For Formally Employed, OFW and Self-employed Professional/Business Owner) 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 New Civil Code as amended by the New Family Code) (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
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.
ANNEX A
GUIDE IN ACCOMPLISHING MEMBER’S DATA FORM (MDF)
FRONT BACK
Submit MDF in one (1) copy and observe the following: Mandatory Coverage
1 Pag-IBIG Membership ID (MID) Number - a unique a. Employed Private - any person in service of a
12-digit number series assigned to a registered private employer and who receives compensation
member. To be accomplished by Pag-IBIG Fund. for such services rendered, may or may not be
registered yet with the Social Security System
2 Registration Tracking Number (RTN) - refers to (SSS); will also include the following:
system-generated number issued after completion of - Expatriates who are not more than sixty (60)
online registration. years old and are compulsorily-covered by the
SSS. An expatriate is a citizen of another
3 Instructions - refers to quick guide in accomplishing country who is living and working in the
the MDF. Philippines.
- Employees of foreign-based employers with an
4 Occupational Status - check the appropriate box to administrative agreement with the Fund
indicate working status of a person either employed or
unemployed/not yet employed. b. Employed Government - any person in service
of any of the government offices that are
5 Membership Category - check the appropriate box to coverable by the GSIS; will also include the
indicate type of membership coverage as defined following:
under R.A. 9679. - Uniformed personnel of the Armed Forces of the
Philippines, Philippine National Police, Bureau
of Fire Protection, Bureau of Jail Management
and Penology
- Members of the Judiciary and Constitutional d. Member of Religious Group - refers to
Commissions individual/head or leader of any organization in
the exercise of religious belief.
c. Overseas Filipino Worker (OFW) - any person
working for a foreign-based employer, whether e. Pensioner - any person receiving old-age or
deployed or for deployment abroad, or a permanent total disability pension or any person
combination of local and overseas deployment, who has received the lump sum excluding one
whether based on land or at sea. receiving survivorship pension benefits; or
d. Self-employed (SE) - any person not over sixty Investor - the owner of investor securities or
(60) years old, who is practicing his/her investor share where investor securities or
profession, or engaged in any trade, business or shares mean shares of stock issued by a Real
occupation, with a monthly average income/
Estate Investment Trust (REIT) or derivatives
earnings of at least P1,000 and is not under an
employer-employee relationship. thereof; or
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10 Member’s Name as Appearing in the Birth 26 Preferred Mailing Address - check the appropriate
Certificate - indicate Member’s name based on Birth box to indicate your chosen address to receive mail.
Certificate. 27 Contact Numbers - indicate the country and area
code only if outside Metro Manila or based abroad.
11 Date of Birth - indicate date of birth in the following
format: mm/dd/yyyy
28 Occupation - indicate your job, profession, or type of
Example: If born on January 14, 1980, please write 01
work to earn a living.
14 1980.
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
- Market Vendor
13 Sex - check the appropriate box. - Farmer
- Fisher Folk
14 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
30 Employer/Business Name - indicate complete
15 Weight - indicate weight in kilograms (kg). Employer/Business Name appearing in the
Conversion: 1 pound (lb) = 0.4536 kilogram registration certificate or employment contract
Example: 120 lbs = 54.43 kg (applicable for Formally Employed, OFW and Self-
employed Professional/Business Owner).
16 Common Reference Number (CRN) - indicate if
available. 31 Employer/Business Address - indicate complete
Employer/Business Address appearing in the
17 Marital Status - check the appropriate box. registration certificate or employment contract
(applicable for Formally Employed, OFW and Self-
18 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 month.
20 Frequency of Membership Savings (MS) Payment -
check appropriate box if payment of MS is not thru 34 Office Assignment - check the appropriate box to
payroll deduction. indicate whether assigned to Head Office or a
particular Branch.
21 Taxpayer Identification Number (TIN) - indicate your
9-digit TIN issued by the Bureau of Internal Revenue 35 Date Employed - indicate inclusive date of
(BIR). employment under current employer.
22 SSS/GSIS Number - for private employees, indicate 36 Previous Employment From Date of Pag-IBIG
your 10-digit Social Security Number, and for Membership - indicate details of your previous
government employees, indicate your 11-digit employment.
Business Partner Number.
23 Employee Number - refers to your company ID 37 Heirs - indicate your legal heir/s in accordance with
number. the Laws of Succession, as provided in the New Civil
For AFP/PNP Employee, indicate Serial/Badge No. Code of the Philippines, as amended by the New
For DepEd Employee, aside from Employee Family Code.
Number, indicate Division Code-Station Code
38 Certification - affix your signature and indicate the
24 Permanent Home Address - indicate the address of date when the MDF was accomplished.
your permanent residence.
39 Acknowledgement - to be accomplished by Pag-IBIG
25 Present Home Address - indicate the address where Fund.
you currently reside, and the state/country only if
present address is outside the Philippines.
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