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AtriumofMakati,MakatiAve.,MakatiCity Tel.Nos.:811-44-01to27(Connectingalldepartments) Pag-IBIG HOUSING LOAN APPLICATION

AtriumofMakati,MakatiAve.,MakatiCity

Tel.Nos.:811-44-01to27(Connectingalldepartments)

Pag-IBIG HOUSING LOAN APPLICATION

Pag-IBIG Fund

H1-11

LOAN PARTICULARS PURPOSE OF LOAN MODE OF PAYMENT AmountofLoanAppliedFor AdditionalLoan Home Improvement House
LOAN
PARTICULARS
PURPOSE OF LOAN
MODE OF PAYMENT
AmountofLoanAppliedFor
AdditionalLoan
Home Improvement
House Construction
PurchaseofaFullyDevelopedLot
Purchaseof HDMFacquiredproperties
PurchaseofaResidentialUnit(House&Lot)
Purchase of Townhouse or Condominium
Unitinclusiveofaparkingslot
Refinancing of an existing
mortgage loan
Bank
P
Over-the-Counter
MaturityofLoanDesired(Years)
SalaryDeduction
PurchaseofLotandConstruction
ofaResidentialUnit
COLLATERAL
Property Location (Street, Municipality, Province)
Is property presentlymortgaged?
DESCRIPTION OF
EXISTING
PROPOSED
IMPROVEMENTS
YES
NO
No.of
Name of Developer/Registered Title Holder
Land Area
STOREYS
TOTAL FLOOR
SQM
AREA
SQM
SQM
TCT/OCT/CCT No.
TaxDeclaration No.
Lot/Unit No.
Block/Bldg. No.
AGE OF HOUSE (For purchase of a residential unit)
BORROWER'S DATA
Surname
FirstName
MiddleName
Pag-IBIGIDNo.
Date of Birth (mm/dd/yy)
Sex
ATTACH HERE
Present Home Address (No., Street, City, Municipality, Province)
ZIP Code
Home Tel. No.
Status
1"x1"
Single
LegallySeparated
ID PHOTO
Married
OF APPLICANT
Others (Pls.specify)
Residence Address (Abroad)
E-mailAddress
Widowed
Home Ownership
Owned
Company
Rented at P
Livingw/relatives/parents
YearsofStay
BusinessTel.No.
Mortgaged
/
/mo.
For Pag-IBIG USE ONLY
Employer/Business Name (if self-employed)
EE SSS/GSIS ID No.
Mobile Phone No./Beeper No.
MONTHLY
Pag-IBIG
CONTRIBUTION
Employer/Business Address
TIN
PhilippineCitizen?
P
Yes
No
LOAN ENTITLEMENT
NatureofBusiness
Position&Department
Years in Employment/Business
No.ofDependent/s
P
BillingAddress
CERTIFIED BY
SPOUSE PERSONAL DATA
Surname
FirstName
MiddleName
Date of Birth (mm/dd/yy)
TIN
Employer/Business Name (If self-employed)
Employer/Business Address
NatureofBusiness
Position&Department
BusinessTel.No.
Years in Employment/Business
BANK ACCOUNTS
(Indicate your three (3) most active)
BANK
BRANCH/ADDRESS
TYPE OF ACCOUNT
ACCOUNT NO.
DATE OPENED
AVE. BALANCE
CREDIT CARDS OWNED
(Indicate your three (3) most active)
CARD COMPANY
BANK ISSUER
CREDIT LIMIT
CARD NO.
EXPIRY DATE
REAL ESTATE OWNED
TYPE OF
ACQUISITION
MARKET
MORTGAGE
RENTAL
LOCATION
TCT NO.
PROPERTY
COST
VALUE
BALANCE
INCOME
OUTSTANDING CREDITS/LOAN AVAILMENTS
Security
Type
MaturityDate
Creditor&Address
Amount/Balance
Mo.Amortization
Creditor&Address
Security
Type
MaturityDate
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.)
MISCELLANEOUS (Answer the
following questions with YES or NO. If your answer is YES, please elaborate on the details as required.)
Aretherepastorpendingcasesagainstyou?
Yes
No
Have you ever been imprisoned?
Yes
No
Ifyes,pleaseindicatethenature,plaintiff,amountinvolvedandthestatus.
Doyouhavepastdueobligations? Ifyes,pleaseindicatethecreditor'sname,nature,amount involvedandduedate.
Yes
No
Wasyourbankaccounteverclosedbecauseofmishandlingorissuanceofbouncingchecks? Ifyes,pleaseindicatethebank'sname,nature,amountanddate.
Yes
No
FINANCIAL INFORMATION ASSETS AND LIABILITIES MONTHLY INCOME AND EXPENSES ASSETS CASH ON HAND/BANK BORROWER
FINANCIAL INFORMATION
ASSETS AND LIABILITIES
MONTHLY INCOME AND EXPENSES
ASSETS
CASH ON HAND/BANK
BORROWER
SPOUSE/OTHERS
INCOME
SALARIES
STOCKS AND BONDS
ALLOWANCES
REAL ESTATE
COMMISSIONS
MOTOR VEHICLES OWNED
RENTAL INCOME
OTHERS (Specify)
OTHERS (Specify)
TOTAL ASSETS
GROSS MONTHLY INCOME
LIABILITIES
WITHHOLDING TAX
UNSECURED LOANS
COMBINED NET MONTHLY INCOME
OTHERS (Specify)
EXPENSES (Combined for Borrower/Spouse/OTHERS)
Living and Utilities
TOTAL LIABILITIES
Education
Transportation
NET WORTH (ASSETS - LIABILITIES)
Loan Amortization
Others (Specify)
Combined Monthly Expenses
Combined Net Disposable Income
LOAN
ENTITLEMENT
LOAN AND CREDIT REFERENCES
HIGHEST
PRESENT
DATE
DATE
BANK/FINANCIAL INSTITUTION
ADDRESS
PURPOSE
SECURITY
AMOUNT OWED
BALANCE
OBTAINED
FULLY PAID
TRADE REFERENCES (For Self-Employed Only)
NAME OF SUPPLIER
ADDRESS
TEL. NO.
CHARACTER REFERENCES
NAME
ADDRESS
TEL. NO.
CERTIFICATION
I/Wecertifythattheforegoinginformation/statementaretothebestofmy/ourknowledge,true,correctandcomplete,andI/Weherebyagreethatanymisrepresentation
ofamaterialfactisagroundfordisapprovaloftheapplication,cancellationoftheloan,orforeclosureofthemortgageasthecasemaybe. I/WeagreetonotifyHDMFofanymaterial
changeaffectingtheinformationcontainedherein. I/WeagreethatallinformationobtainedbyHDMFshallremainitspropertywhetherornottheloanisgranted.
I/WefurtheragreetopayHDMFthenon-refundablesumofOneThousandPesos(P1,000.00)asprocessing/filingfeetobepaiduponfillingoftheloanapplicationandTwo
ThousandPesos(P2,000.00)tobepaiduponloantakeout. I/Weunderstandthatshouldmy/ourapplicationbeapproved,notarialandallotherfeespertainingtotheregistrationof
mortgageofpropertyshallbeformy/ouraccount. Thesignatureappearingbelowaregenuine.
SIGNATURE OF BORROWER
SIGNATURE OF SPOUSE
DATE
DATE
JURAT
REPUBLIC OF THE PHILIPPINES)
S.S.
PROVINCE/CITYOF
)
SUBSCRIBED AND SWORN TO BEFORE ME THIS
TH
DAY OF
,
20
AT
,
BY THE FOLLOWING:
Name of Borrower/s/Co-Borrower/s
Com. Tax Cert. No.
Date of Issue
Place of Issue
NOTARY PUBLIC
Doc.
Page
Book
Series
FOR Pag-IBIG USE ONLY
SIGNATURE OF Pag-IBIG Fund REPRESENTATIVE
NAME IN PRINT
DATE RECEIVED
RECEIVED BY
THIS
FORM
CAN
BE
REPRODUCED.
NOT FOR SALE