HQP-SLF-017

SHORT-TERM LOAN
Pag-IBIG EMPLOYER’S ID NUMBER

REMITTANCE FORM (STLRF)

NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.
EMPLOYER/BUSINESS NAME

EMPLOYER/BUSINESS ADDRESS PERIOD COVERED

Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Stree Name
t

Subdivision Barangay Municipality/City Province/State/Country (i abroad) ZI Code TELEPHONE NUMBER

f P

NAME OF MEMBERS
Pag-IBIG APPLICATION NO. LOAN TYPE EMPLOYER
Last Name First Name Name Extension Middle Name AMOUNT
MID NO. (e.g., MPL, Calamity Loan) REMARKS
(Jr., III, etc.)

TOTAL FOR THIS PAGE

GRAND TOTAL (if last page)

EMPLOYER CERTIFICATION

I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best of my knowledge and belief. I
further certify that my signature appearing herein is genuine and authentic.

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE DESIGNATION/POSITION DATE

(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

(V02, 10/2016)
 GUIDELINES AND INSTRUCTIONS
a. Type or print all entries in BLOCK or CAPITAL LETTERS.
f. Failure or refusal of the Employer to pay or to remit the
b. Accomplish this form in softcopy when making remittances to Pag-IBIG Fund contributions herein prescribed shall not prejudice the right of the
or to any accredited collecting partner on or before the fifteenth (15 th) day of covered employee to the benefits under the Fund. Such Employer
the month. shall be charged a penalty equivalent to 1/10 of 1% per day of
delay of the amount due starting on the first day immediately
c. A separate Short-Term Loan Remittance Form (STLRF) should be following the due date until the date of full settlement.
accomplished per type of payment (whether cash or check payment) and in 1
case Credit Memo shall be applied as payment to the Fund. Pag-IBIG Employer’s ID No. – assigned Pag-IBIG Employer’s ID
Number.
d. In case there is a correction in the remittance which resulted to overpayment, 2
the employer shall advise the Fund. Once validated, a Notice of Employer/Business Name – per DTI/SEC Registration.
Overpayment and Credit Memo shall be issued to the employer. From the
date of issuance of the said Notice, the employer may request, not later than Employer/Business Address - indicate Unit/Room No., Floor,
six (6) months for refund of the excess amount or have it applied to the future 3 Building Name or Lot No., Block No., Phase No. or House No. and
remittance with the Fund. Street Name, Subdivision, Barangay, Municipality/City, Province,
and ZIP Code.
e. The total amount to be remitted should be equal to the total amount reflected
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on the STLRF. Check payments should be made payable to Pag-IBIG Fund
and shall be posted upon clearing (clearing policy shall not be applicable to Period Covered – indicate the applicable month and year of MS
National Government Agency (NGA), instead payment shall be posted within remittance in the following format: yyyy/mm.
72 hours upon receipt of collection).
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Telephone Number – indicate current telephone number.
6 Pag-IBIG MID No. – indicate the borrower’s assigned Pag-IBIG
Membership Identification (MID) Number.
7 Application No. – indicate the borrower’s loan application number
1 per type of loan.

8 Name of Borrower – indicate borrower’s complete name in the

2 following format: Last Name, First Name, Name Extension (Jr., III,
etc.), Middle Name
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3
9 Loan Type – indicate if payment is intended for Multi-Purpose
5 Loan (MPL) or Calamity Loan (CL) in the following format: MPL or
CL
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6 7 8 9 10
11 Amount – indicate the amount due as indicated in the latest billing
statement

11 Employer Remarks – accomplish this portion only to report

changes in the borrower’s employment status and to update any
information regarding the borrower. Indicate the appropriate code
and effectivity date in the following formate (mm/dd/yy) on the
space provided. Please refer to the following codes and examples.

N - Newly Hired Examples

L - Leave Without Pay/AWOL 1. N: 1/4/2013
RS - Resigned/Separated 2. L: 1/21/2013
RT - Retired 3. RS: 1/3/2013
D - Deceased 4. D: 1/14/2013
O - Others, please specify reason

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Indicate the total amount due per page.

13 Indicate the grand total of the total amount due if this is the last
page.

12 14 Employer Certification - to be accomplished and duly signed by

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the Head of Office/Authorized Representative.

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