FLH020

FLH020

MEMBERSHIP STATUS
VERIFICATION SLIP
Date Filed: __________
Last Name

MSVS No. ______________

First Name

Middle Name

Maiden Name

(For married women)

MEMBERSHIP STATUS
VERIFICATION SLIP
Date Filed: __________
Last Name

MSVS No. ______________

First Name

Middle Name

Maiden Name

(For married women)

Home Address

Tel. No.

Home Address

Tel. No.

Company/Employer/Business Name

Employer ID No.

Company/Employer/Business Name

Employer ID No.

Company/Employer/Business Address

Tel. No.

Company/Employer/Business Address

Tel. No.

Status

Status

Single

Annulled

Branch of Service

For AFP
Employee
For DECS
Employee

Legally
Separated

Widow/er

Married

Division Code

Single

Serial/Account No.
Station Code

Employee No.

Widow/er

Married

Division Code

For DECS
Employee

House Construction
Purchase of a Fully Developed Lot
Purchase of Lot and Construction of
a Residential Unit

Refinancing of an existing mortgage

loan

EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP

NAME OF EMPLOYER/ADDRESS

Employee No.

Purchase of Pag-IBIG acquired

properties
Purchase of a Residential Unit
Purchase of Townhouse and
Condominium Unit, inclusive of parking
slot

Home Improvement
House Construction
Purchase of a Fully Developed Lot
Purchase of Lot and Construction
of a Residential Unit

Refinancing of an existing mortgage

loan

EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP

NAME OF EMPLOYER/ADDRESS

FROM (Mo./Yr.) TO (Mo./Yr.)

Member's
Signature

FOR Pag-IBIG FUND USE ONLY

FOR Pag-IBIG FUND USE ONLY

COUNSELLED/PRE-QUALIFIED BY (Counseling Section/Servicing Section) Date

With Without

COUNSELLED/PRE-QUALIFIED BY (Counseling Section/Servicing Section) Date

Remarks

Verified by

Remarks

With Without Verified by

CLAIMS
MPL
HL/LP/HI

CLAIMS
MPL
HL/LP/HI

Pag-IBIG Loan as of

Pag-IBIG Loan as of

LATEST CONTRIBUTION RECORD

Month/Year
PFR No./Date

Amount

Total No. of
Contributions

Maximum Allowable Rate (MAR)

Date

For Provident Benefits Division

Certified by

Station Code

Additional Loan

FROM (Mo./Yr.) TO (Mo./Yr.)

Member's
Signature

Verified by

Serial/Account No.

LOAN PURPOSE

Purchase of Pag-IBIG acquired

properties
Purchase of a Residential Unit
Purchase of Townhouse and
Condominium Unit, inclusive of parking
slot

Home Improvement

Annulled

Branch of Service

For AFP
Employee

LOAN PURPOSE
Additional Loan

Legally
Separated

Date

Remarks

Amount

Total No. of
Contributions

Maximum Allowable Rate (MAR)

Verified by

Loan Entitlement
For Servicing Department/Section

Certified by

Remarks

Date

Date

For Provident Benefits Division

Certified by

Date

Remarks

Attachments
Certificate of Remittance

LATEST CONTRIBUTION RECORD

Month/Year
PFR No./Date

Loan Entitlement
For Servicing Department/Section

Certified by

Remarks

Attachments
Latest Payslip

Certificate of Remittance

Latest Payslip

Date