HQP-HLF-068

HOUSING LOAN APPLICATION

Tracking No

Pag-IBIG MID Number/RTN

1 2 1 0

8 2 3 3

5 2 8 2

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

LOAN PARTICULARS
DESIRED LOAN AMOUNT

PURPOSE OF LOAN

Purchase of Fully Developed Lot or Adjoining Lots

Purchase of Fully Developed Lot and Construction of
a Residential Unit
Purchase of Pag-IBIG Fund Acquired Properties
Purchase of a Residential Unit (House & Lot)
Purchase of Townhouse or Condominium Unit
Purchase of Townhouse or Condominium Unit
inclusive of a parking slot
Purchase of Adjoining Property
Refinancing of an Existing Mortgage Loan
House Construction
Home Improvement

300,000.00

Purchase of a Residential Unit with Home

Improvement
Refinancing of an Existing Mortgage with
Home Improvement
Refinancing of an Existing Mortgage with Construction
of a Residential Unit
Additional Loan: House Construction
Additional Loan: Home Improvement
Additional Loan: Purchase of Adjacent Property
Additional Loan: Purchase of Parking Lot (for vertical
development)
Assumption: Successor in Interest

DESIRED LOAN TERM (Years)

10
DESIRED RE-PRICING PERIOD (Years)

5
MODE OF PAYMENT

Salary deduction
Over-the-Counter
Post-Dated
Checks

Cash/Check

Collecting Agent
Bank
Developer
Remittance
Center

COLLATERAL
IS PROPERTY PRESENTLY
MORTGAGED?

PROPERTY LOCATION (Street, Municipality, Province)

YES

NO

0 SQM
TAX DECLARATION NO.

EXISTING

PROPOSED

No. of
STOREYS

LAND AREA

NAME OF DEVELOPER/REGISTERED TITLE HOLDER

TCT/OCT/CCT NO.

DESCRIPTION OF
IMPROVEMENTS

LOT/UNIT NO.

BLOCK/BLDG NO.

TOTAL FLOOR
AREA

0 SQM
AGE OF HOUSE (For Purchase of a Residential Unit)

0 SQM

BORROWERS DATA
LAST NAME

FIRST NAME

CHAVEZ

ARIEL

NAME EXTENSION

MIDDLE NAME

CITIZENSHIP

PUNONGBAYAN

FILIPINO

DATE OF BIRTH (mm/dd/yy)

SEX

October 22, 1984

MARITAL STATUS

PERMANENT HOME ADDRESS

174 BACLARAN CABUYAO LAGUNA PHILIPPINES 4025

ATTACH HERE
1X1
ID PHOTO
OF APPLICANT

Legally
Separated
Annulled

Single/
Unmarried
Married
Widow/er

CONTACT DETAILS (Indicate country code

PRESENT HOME ADDRESS

if abroad)

174 BACLARAN CABUYAO LAGUNA PHILIPPINES 4025

For HDMF USE ONLY

COUNTRY + AREA CODE TELEPHONE NO.

Home

HOME OWNERSHIP
Owned
Company
Living w/ relatives/parents
Mortgaged
Rented
EMPLOYER/BUSINESS NAME (If self-employed)

YEARS OF STAY IN
PRESENT HOME
ADDRESS

EE SSS/GSIS ID No.

0278032421

Cell Phone

09157414089

LOAN ENTITLEMENT

Email Address

27

ayel.wf4@gmail.com

TIN

GENPACT PHILIPPINES LLC

413155306

EMPLOYER/BUSINESS ADDRESS

OCCUPATION
Self-Employed

Employed

MUNTINLUPA PHILIPPINES 1773

MONTHLY HDMF
CONTRIBUTION

CONTACT DETAILS (Indicate country code CERTIFIED BY

if abroad)
COUNTRY + AREA CODE TELEPHONE NO.

Business (Direct Line)

YEARS IN
EMPLOYMENT/
BUSINESS

Business (Trunk Line)

5
Employer/Business Email Address

INDUSTRY
Accounting
Activities of Private
Households as
Employers &
Undifferentiated
Production Activities
of Private
Households
Agriculture, Hunting,
Forestry & Fishing

Basic Materials
Construction
Education & Training
Electricity, Gas and
Water Supply
Extra-Territorial
Organization & Bodies
Financial Services/
Intermediation
HR/Recruitment

Health and Social Work;

Health and Medical Services
Life Sciences
Management
Manufacturing
Media
Mining and Quarrying
Other Community, Social &
Personal Service Activities
Public Administration & Defense;
Compulsory Social Security

Technology
Transport, Storage
and Communications
Travel and Leisure
Wholesale & Retail
Trade; Repair of
Motor Vehicles,
Motorcycles,
Personal &
Household Goods

NO. OF
DEPENDENT/S

2
POSITION & DEPARTMENT

PROCESS DEVELOPER / COLLECTION

PREFERRED MAILING ADDRESS
Present Home Address
Employer/Business Address
Permanent Home Address

SPOUSES PERSONAL DATA

LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE NAME

CITIZENSHIP

DATE OF BIRTH (mm/dd/yy) TIN

EMPLOYER/BUSINESS NAME (If self-employed)

YEARS IN EMPLOYMENT/
BUSINESS

0
OCCUPATION
Self-Employed
Employed
Unemployed

EMPLOYER/BUSINESS ADDRESS

INDUSTRY
Accounting
Activities of Private Households as
Employers & Undifferentiated
Production Activities of Private
Households
Agriculture, Hunting, Forestry &
Fishing
Basic Materials

Construction
Education & Training
Electricity, Gas and Water Supply
Extra-Territorial Organization & Bodies
Financial Services/ Intermediation
HR/Recruitment
Health and Social Work;
Health and Medical Services

Life Sciences
Management
Manufacturing
Media
Mining and Quarrying
Other Community, Social & Personal
Service Activities
Public Administration & Defense;
Compulsory Social Security

POSITION & DEPARTMENT

/
BUSINESS TEL. NO.

Technology
Transport, Storage and Communications
Travel and Leisure
Wholesale & Retail Trade; Repair of Motor
Vehicles, Motorcycles, Personal &
Household Goods

(Revised/August 2012)

GROSS MONTHLY INCOME

PARTICULARS

PRINCIPAL BORROWER

BASIC MONTHLY COMPENSATION

SPOUSE

14,000.00
6,000.00

COST OF LIVING ALLOWANCE

OTHER SOURCE/S

0.00
0.00
0.00

2,000.00
22,000.00

TOTAL

0.00

BANK ACCOUNTS (Indicate your 3 most active)

BANK

BDO

BRANCH/ADDRESS

TYPE OF ACCOUNT

AYALA, ALABANG

SAVINGS

CREDIT CARDS OWNED (Indicate your 3 most active)

CARD TYPE
(e.g. Visa/Mastercard)

ISSUER NAME

CARD EXPIRY
(mm/yyyy)

CREDIT LIMIT

REAL ESTATE OWNED

LOCATION

TYPE OF PROPERTY

ACQUISITION COST

MARKET VALUE

MORTGAGE
BALANCE

RENTAL INCOME

OUTSTANDING CREDITS/LOAN AVAILMENTS

Creditor & Address

Security

Creditor & Address

Security

Creditor & Address

Security

Type

Maturity Date

Amount/Balance

Mo. Amortization

Type

Maturity Date

Amount/Balance

Mo. Amortization

Type

Maturity Date

Amount/Balance

Mo. Amortization

MISCELLANEOUS
(Answer the following questions with YES or NO. If your answer is YES, please elaborate on the details as required)

Are there past or pending cases against you?

Yes
No
If Yes, please indicate the nature, plaintiff, amount involved and the status.
Do you have past due obligations? If yes, please indicate the creditors name, nature, amount involved and due date.

Yes
No
Was your bank account ever closed because of mishandling or issuance of bouncing checks? If yes, please indicate the banks name, nature amount and date.

Yes
No

LOAN AND CREDIT REFERENCES

ADDRESS

BANK/FINANCIAL INSTITUTION

PURPOSE

SECURITY

HIGHEST
AMOUNT OWED

PRESENT
BALANCE

DATE
OBTAINED

DATE
FULLY PAID

TRADE REFERENCES (For Self-Employed Only)

NAME OF SUPPLIER

ADDRESS

TEL. NO.

CHARACTER REFERENCES
NAME

ADDRESS

TEL. NO.

CERTIFICATION
I/We certify that the foregoing information/statement is to my/our knowledge, true, correct, complete, and updated. The signature/s appearing below is/are
genuine. I/We authorize Pag-IBIG Fund to conduct verification on all the details stated on this document as well as the other documents I/We have submitted from
whatever source that it may consider appropriate to establish its correctness, validity, and authenticity.
I/We hereby agree that any misrepresentation of a material fact is a ground for disapproval of the application, cancellation of the loan, and shall be a cause for
the total outstanding obligation to be due and demandable and shall be subject to other sanctions provided in existing Pag-IBIG guidelines. I/We agree to notify PagIBIG Fund of any material change affecting the information contained herein. I/We agree that all information obtained by Pag-IBIG Fund shall remain its property
whether or not the loan is granted.
I/We further agree to pay Pag-IBIG Fund a non-refundable sum of One Thousand Pesos (P1,000.00) as processing/filing fee to be paid upon filing of the loan
application and Two Thousand Pesos (P2,000.00) to be paid upon loan takeout. I/We understand that should my/our application be approved, notarial and all other
fees pertaining to the registration of mortgage on property shall be for my/our account.

____________________________________
SIGNATURE OF BORROWER

____________________________________
SIGNATURE OF SPOUSE

____________________________________
DATE

____________________________________
DATE

THIS FORM CAN BE REPRODUCED. NOT FOR SALE.