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FLS010

Pag-IBIG MULTI-PURPOSE LOAN APPLICATION FORM (MPLAF)
(TO BE FILLED OUT BY APPLICANT)
LAST NAME FIRST NAME

APPLICATION No.

Type or print entries MIDDLE NAME MAIDEN NAME (For married women) DESIRED LOAN AMOUNT MAX OF 60% (24-59 MOS.) MAX OF 80% (AT LEAST 120 MOS.) MAX OF 70% (60-119 MOS.) OTHER AMOUNT, PLS. SPECIFY _______________ HOME ADDRESS (Pls. indicate complete address) GENDER CIVIL STATUS EMPLOYEE No. MALE SINGLE WIDOW/ER ANNULLED FEMALE MARRIED LEGALLY SEPARATED MOTHER'S MAIDEN NAME MOBILE PHONE No. HOME TEL. No. TIN

BIRTHDATE mm dd

BIRTHPLACE yyyy

Pag-IBIG ID No.

SSS/GSIS ID No.

COMPANY/EMPLOYER NAME

COMPANY/EMPLOYER ADDRESS (Pls. indicate complete address)

FOR AFP EMP-SERIAL/ACCOUNT No. FOR DECS EMP - DIV. CODE/STATION CODE/ EMPLOYEE No. OFFICE TEL. NO. TYPE OF LOAN LOAN PURPOSE NEW RENEWAL PAYMENT OF HOUSING LOAN ARREARAGES (Mo.Yr.) FROM(Mo./Yr.) TO (Mo./Yr.) OTHER HOUSINGRELATED NONHOUSING RELATED

EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP
NAME OF EMPLOYER

(Use another sheet if necessary)

DATE OF Pag-IBIG MEMBERSHIP
ADDRESS

SIGNATURE OF APPLICANT IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR MULTI-PURPOSE LOAN, I HEREBY AUTHORIZE Pag-IBIG FUND TO CREDIT MY LOAN PROCEEDS THROUGH MY PAYROLL BANK ACCOUNT THAT I HAVE INDICATED ON THE RIGHT PORTION.

MEMBER'S PAYROLL BANK ACCOUNT NO.

NAME OF BANK/BRANCH (Where member maintains payroll account) BANK ADDRESS

APPLICATION AGREEMENT
In consideration of the loan that may be granted by virtue of this application subject to the pertinent provisions of the Implementing Rules and Regulations of the Pag-IBIG Fund, I hereby waive my rights under R.A. No. 1405 and authorize Pag-IBIG Fund to verify/validate my payroll account number. Furthermore, I hereby authorize my present employer ____________________________________________________________

__________________ or any employer with whom I may get employed in the future, to deduct the monthly...