HQP-HLF-068

HOUSING LOAN APPLICATION

Pag-IBIG MID Number

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

LOAN PARTICULARS
DESIRED LOAN AMOUNT
PURPOSE OF LOAN

Purchase of Fully Developed Lot
Home Improvement

Purchase of Fully Developed Lot and
House Construction DESIRED LOAN TERM (Years)
Construction of a Residential Unit
Purchase of a Residential Unit with Home Improvement

Purchase of Pag-IBIG Fund Acquired Properties
Refinancing of an Existing Mortgage with

Purchase of a Residential Unit (House & Lot) Home Improvement MODE OF PAYMENT

Purchase of Townhouse or Condominium Unit
Refinancing of an Existing Mortgage with Construction of a  Salary deduction  Collecting Agent

Purchase of Townhouse or Condominium Unit inclusive of a Residential Unit  Over-the-Counter  Bank
parking slot
Additional Loan: House Construction  Post-Dated  Developer

Additional Loan: Home Improvement Checks  Remittance

Refinancing of an Existing Mortgage Loan  Cash/Check Center

COLLATERAL
PROPERTY LOCATION (Street, Municipality, Province) IS PROPERTY PRESENTLY DESCRIPTION OF
MORTGAGED? EXISTING PROPOSED
IMPROVEMENTS
 YES  NO
No. of
NAME OF DEVELOPER/REGISTERED TITLE HOLDER LAND AREA STOREYS

SQM TOTAL FLOOR

TCT/OCT/CCT NO. TAX DECLARATION NO. LOT/UNIT NO. BLOCK/BLDG NO. AREA SQM SQM
AGE OF HOUSE (For Purchase of a Residential Unit)

BORROWERS DATA
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME CITIZENSHIP DATE OF BIRTH (mm/dd/yy) SEX
M F
PERMANENT HOME ADDRESS MARITAL STATUS ATTACH HERE
Unit/Room No., Floor Building Name Lot No., Blk No., Phase No., House No. Street Name  Single/  Legally 1X1
Unmarried Separated ID PHOTO
Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code  Married  Annulled/Divorced OF APPLICANT
 Widow/er
PRESENT HOME ADDRESS CONTACT DETAILS (Indicate country code
Unit/Room No., Floor 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) Zip Code Home MONTHLY HDMF
CONTRIBUTION

Cell Phone
HOME OWNERSHIP YEARS OF STAY IN EE SSS/GSIS ID No.
PRESENT HOME
 Owned  Company  Living w/ relatives/parents ADDRESS LOAN ENTITLEMENT
Email Address
 Mortgaged  Rented at P__________/mo.
EMPLOYER/BUSINESS NAME (If self-employed) TIN
CONTACT DETAILS (Indicate country code CERTIFIED BY
if abroad)
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name COUNTRY + AREA CODE TELEPHONE NO.
Business (Direct Line)
YEARS IN
Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code EMPLOYMENT/
Business (Trunk Line) BUSINESS

Employer/Business Email Address

INDUSTRY NO. OF

Accounting
Basic Materials
Health and Social Work;
Technology DEPENDENT/S

Activities of Private
Construction Health and Medical Services
Transport, Storage
Households as
Education & Training
Life Sciences and Communications
Employers &
Electricity, Gas and
Management
Travel and Leisure
POSITION & DEPARTMENT/OCCUPATION
Undifferentiated Water Supply
Manufacturing
Wholesale & Retail
Production Activities
Extra-Territorial
Media Trade; Repair of
of Private Organization & Bodies
Mining and Quarrying Motor Vehicles, PREFERRED MAILING ADDRESS
Households
Financial Services/
Other Community, Social & Motorcycles,

Agriculture, Hunting, Intermediation Personal Service Activities Personal &
Present Home Address
Forestry & Fishing
HR/Recruitment
Public Administration & Defense; Household Goods
Employer/Business Address
Compulsory Social Security
Permanent Home Address

SPOUSES PERSONAL DATA

LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME CITIZENSHIP DATE OF BIRTH (mm/dd/yy) TIN

EMPLOYER/BUSINESS NAME (If self-employed) YEARS IN EMPLOYMENT/

BUSINESS

EMPLOYER/BUSINESS ADDRESS POSITION &

Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name DEPARTMENT/OCCUPATION

Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code BUSINESS TEL. NO.

INDUSTRY

Accounting
Construction
Life Sciences
Technology

Activities of Private Households as
Education & Training
Management
Transport, Storage and Communications
Employers & Undifferentiated
Electricity, Gas and Water Supply
Manufacturing
Travel and Leisure
Production Activities of Private
Extra-Territorial Organization & Bodies
Media
Wholesale & Retail Trade; Repair of Motor
Households
Financial Services/ Intermediation
Mining and Quarrying Vehicles, Motorcycles, Personal &

Agriculture, Hunting, Forestry &
HR/Recruitment
Other Community, Social & Personal Household Goods
Fishing
Health and Social Work; Service Activities

Basic Materials Health and Medical Services
Public Administration & Defense;
Compulsory Social Security

(April 2012)
 BANK ACCOUNTS (Indicate your 3 most active)
TYPE OF
BANK BRANCH/ADDRESS ACCOUNT NO. DATE OPENED AVE. BALANCE
ACCOUNT

CREDIT CARDS OWNED (Indicate your 3 most active)

CARD TYPE CARD EXPIRY
ISSUER NAME CREDIT LIMIT
(e.g. Visa/Mastercard) (mm/yyyy)

REAL ESTATE OWNED

TYPE OF ACQUISITION MORTGAGE
LOCATION TCT NO. MARKET VALUE RENTAL INCOME
PROPERTY COST BALANCE

OUTSTANDING CREDITS/LOAN AVAILMENTS

Creditor & Address Security Type Maturity Date
Amount/Balance Mo. Amortization
Creditor & Address Security Type Maturity Date
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

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/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 that 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.
I/We further agree to pay Pag-IBIG Fund a non-refundable sum of One Thousand Pesos (P1,000.00) as processing/filing fee to be paid upon filing of the loan
application and Two Thousand Pesos (P2,000.00) to be paid upon loan takeout. I/We understand that should my/our application be approved, notarial and all other
fees pertaining to the registration of mortgage on property shall be for my/our account.

____________________________________ ____________________________________
SIGNATURE OF BORROWER SIGNATURE OF SPOUSE

____________________________________ ____________________________________
DATE DATE

THIS FORM CAN BE REPRODUCED. NOT FOR SALE.