HQP-HLF-069
HOUSING LOAN APPLICATION
(For Co-Borrower Only)
Pag-IBIG MID Number/RTN
(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)
CO-BORROWERS DATA
LAST NAME
FIRST NAME
NAME EXTENSION
CITIZENSHIP
MIDDLE NAME
DATE OF BIRTH (mm/dd/yy)
SEX
M F
MARITAL STATUS
PERMANENT HOME ADDRESS
Unit/Room No., Floor
Building Name
Lot No., Blk No., Phase No., House No.
Street Name
Single/
Unmarried
Subdivision
Barangay
Municipality/City
Province and State Country (if abroad)
Zip Code
Separated
Married
Widow/er
Annulled
CONTACT DETAILS (Indicate country code
PRESENT HOME ADDRESS
Unit/Room No., Floor
ATTACH HERE
1X1
ID PHOTO
OF APPLICANT
Legally
Building Name
Lot No., Block No., Phase No., House No.
Street Name
if abroad)
For HDMF USE ONLY
COUNTRY + AREA CODE TELEPHONE NO.
Subdivision
Barangay
Municipality/City
Province and State Country (if abroad)
YEARS OF STAY IN
PRESENT HOME
ADDRESS
HOME OWNERSHIP
Owned
Mortgaged
Company
Living w/ relatives/parents
Rented at P__________/mo.
Zip Code
EE SSS/GSIS ID No.
MONTHLY HDMF
CONTRIBUTION
Home
Cell Phone
LOAN ENTITLEMENT
Email Address
EMPLOYER/BUSINESS NAME (If self-employed)
TIN
EMPLOYER/BUSINESS ADDRESS
OCCUPATION
Employed
Self-Employed
CONTACT DETAILS (Indicate country code CERTIFIED BY
Unit/Room No., Floor
Building Name
Subdivision
Lot No., Block No., Phase No., House No Street Name.
Barangay
Municipality/City
Province and State Country (if abroad)
if abroad)
COUNTRY + AREA CODE TELEPHONE NO.
Business (Direct Line)
YEARS IN
EMPLOYMENT/
BUSINESS
Zip Code
Business (Trunk Line)
INDUSTRY
NO. OF
DEPENDENT/S
Employer/Business Email Address
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
POSITION & DEPARTMENT
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)
EMPLOYER/BUSINESS NAME (If self-employed)
YEARS IN EMPLOYMENT/
BUSINESS
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor
Street Name
Building Name
Subdivision
Barangay
INDUSTRY
Accounting
Activities of Private Households
as Employers &
Undifferentiated Production
Activities of Private Households
Agriculture, Hunting, Forestry &
Fishing
Basic Materials
TIN
Lot No., Block No., Phase No., House No.
Municipality/City
OCCUPATION
Employed
Self-Employed
Province and State Country (if abroad)
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
Zip Code
POSITION & DEPARTMENT
BUSINESS TEL. NO.
Technology
Transport, Storage and Communications
Travel and Leisure
Wholesale & Retail Trade; Repair of Motor
Vehicles, Motorcycles, Personal &
Household Goods
GROSS MONTHLY INCOME
PARTICULARS
CO-BORROWER
SPOUSE
BASIC MONTHLY COMPENSATION
COST OF LIVING ALLOWANCE
OTHER SOURCE/S
TOTAL
BANK ACCOUNTS (Indicate your 3 most active)
BANK
BRANCH/ADDRESS
TYPE OF ACCOUNT
ACCOUNT NO.
DATE OPENED
AVE. BALANCE
(Revised/August 2012)
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
Type
Maturity Date
Amount/Balance
Mo. Amortization
Maturity Date
Creditor & Address
Security
Type
Amount/Balance
Mo. Amortization
Creditor & Address
Security
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
BANK/FINANCIAL INSTITUTION
ADDRESS
PURPOSE
HIGHEST
AMOUNT OWED
SECURITY
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 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 Pag-IBIG 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.
____________________________________
SIGNATURE OF CO-BORROWER
____________________________________
SIGNATURE OF SPOUSE
____________________________________
DATE
____________________________________
DATE
THIS FORM CAN BE REPRODUCED. NOT FOR SALE
