HQP-PFF-039
(V07, 10/2017)
FOR Pag-IBIG Fund USE ONLY
MEMBER’S DATA FORM Pag-IBIG MID NUMBER
(MDF) REGISTRATION TRACKING NUMBER
919274829088
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.
*OCCUPATIONAL STATUS EMPLOYED UNEMPLOYED/NOT YET EMPLOYED
*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 EARNING GROUPS (OEGs) MEMBER OF RELIGIOUS GROUP OTHERS, Please specify
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 MACARAIG FERNANDO REAL
FATHER MACARAIG RICARDO SAMSON
*MOTHER (Maiden Name) REAL LEONCIA ARELLANO
*SPOUSE (If Married) ARELLANO NOBE BOBADILLA
MEMBER’S NAME AS APPEARING
IN THE BIRTH CERTIFICATE MACARAIG FERNANDO REAL
*DATE OF BIRTH *MARITAL STATUS TAXPAYER IDENTIFICATION NUMBER (TIN)
0 5 3 0 1 9 6 6 Single/Unmarried Widow/er Annulled
Married Legally Separated 1 5 1 2 4 8 3 0 8
m m d d y y y y
*PLACE OF BIRTH (City/Municipality/Province/Country) *CITIZENSHIP SSS/GSIS NUMBER
(Please indicate country if born outside the Philippines) 3 3 3 1 3 6 0 9 3 7
IBAAN, BATANGAS FILIPINO
EMPLOYEE NUMBER
*SEX HEIGHT WEIGHT PROMINENT DISTINGUISHING FACIAL FEATURES
Male (Ex. Moles, Scars, etc.)
154 (cm) 72 (kg) For AFP/PNP Employee, Serial/Badge No.
Female ______ ______
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
174 Home
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
TULAY IBAAN Cell Phone
BATANGAS 4230
0938 6507790
*PRESENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name Business (Direct Line)
174
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code Business (Trunk Line) Local
TULAY IBAAN
BATANGAS 4230
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
(V07, 10/2017)
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)
HELPERSPIPELAYERS, PLUMBERS, (Pls. specify country of assignment)
PIPEFITTERS, AND STEAMFITTERS 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
16,000.00
PIPETECH CONSTRUCTION Basic
+
Allowances/Others 0.00
*EMPLOYER/BUSINESS ADDRESS (For Formally Employed, OFW and Self-employed Professional/Business Owner)
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. =
656 Total Mo. Income 16,000.00
Street Name Subdivision Barangay OFFICE ASSIGNMENT LIMA
MANGGAHAN
Head Office Branch ____________
Municipality/City Province State/Country (If abroad) ZIP Code DATE EMPLOYED (Month, Year)
PASIG CITY 1611 June 2015
PREVIOUS EMPLOYMENT FROM DATE OF Pag-IBIG Fund MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
TECHNOPIPE
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS FROM TO
PASIG CITY 0 6 2 0 1 1 0 5 2 0 1 5
m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
SIDACA
Head Office Branch ____________
EMPLOYER/BUSINESS ADDRESS FROM TO
PASIG CITY 0 6 2 0 0 0 0 1 2 0 1 0
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)
NAME NO MIDDLE NAME
LAST NAME FIRST NAME MIDDLE NAME RELATIONSHIP DATE OF BIRTH
EXTENSION (Check only if applicable)
DAUGHTER 1 0 2 8 1 9 9 5
MACARAIG JANE MARIZ ARELLANO
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.
10/01/2019
______________________________________ _________________
SIGNATURE OF MEMBER 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.
