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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 Pag-IBIG contribution and amortization due from my salary and remit the same to Pag-IBIG Fund. If the resulting monthly net take home pay after deducting the computed monthly amortization on MPL falls below the monthly net take home pay as required under the GAA/company policy, I authorize Pag-IBIG Fund to compute for a lower loanable amount. Should I be classified as having an outstanding housing loan account in arrears for more than 9 months upon loan application but said account is not yet cancelled or foreclosed, I hereby assign the proceeds of the loan to Pag-IBIG Fund and authorize the latter to apply the said proceeds to the payment of my housing loan arrearages. I understand that should I fail to pay the monthly amortization due, I shall be charged a penalty of 1/2% of any unpaid amount for every month of delay. I further authorize my employer to deduct the outstanding balance of my MPL from my retirement and/or separation pay and remit the same to Pag-IBIG Fund. This authorization is irrevocable until such time that the said loan is fully paid. In the event my retirement and/or separation pay is not sufficient to settle the outstanding balance of my MPL or my employer fails, for whatever reason, to deduct the same from said retirement and/or separation pay in settlement of the outstanding balance of my MPL, I hereby authorize Pag-IBIG Fund to apply whatever benefits are due me from the Fund to settle the said obligation. I certify that the information given and any or all statements made herein are true and correct to the best of my knowledge and belief. I hereby certify under pain of perjury that my signature and thumbmarks appearing herein are genuine and authentic. _________________________________________ HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE (Signature over printed name)

This office agrees to collect the corresponding monthly amortizations on this loan and the monthly Pag-IBIG contributions of herein applicant through payroll deduction,...
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