OWNED (Indicate your 3

most active)
HQP-AAF-116
BUYER’S INFORMATION SHEET
(For Purchase of Acquired Assets thru Long-Term Installment Sale)
Pag-IBIG MID NO./RTN HL Account Number if with existing HL Account

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

PURCHASE PARTICULARS
TYPE OF Pag-IBIG FUND ACQUIRED ASSET DESIRED INSTALLMENT TERM (Years) MODE OF PAYMENT
 Fully Developed Residential Lot  Salary deduction  Over-the-Counter  Collecting Agent
 Residential Unit  Post-Dated Checks  Remittance Center
 Cash/Check  Bank
PURCHASE PRICE DESIRED RE-PRICING PERIOD (Year/s) WITH EXISTING HOME FINANCING APPLICATION
1 3 5  10  YES  NO
_____________________________________________________________
 15  20  25  30 If yes, indicate Home Financing Application No. _________________________

PROPERTY LOCATION
Unit/Rm. No., Floor Building Name Lot No., Blk No., Phase No., House No. Street Name Subdivision

Barangay Municipality/City Province and State Country (if abroad) Zip Code

BUYER’S DATA
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME SEX
M ATTACH HERE
F 1”X1”
CITIZENSHIP DATE OF BIRTH (mm/dd/yy) EE SSS/GSIS ID NO. TIN ID PHOTO
OF APPLICANT

PERMANENT HOME ADDRESS MARITAL STATUS

Unit/Room No., Floor Building Name Lot No., Blk No., Phase No., House No. Street Name  Single/Unmarried  Married
 Legally Separated  Annulled
 Widow/er
Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code NO. OF DEPENDENT/S

PRESENT HOME ADDRESS BUYER’S CONTACT DETAILS

Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name (Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NO.
Home
Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code

Cell Phone
HOME OWNERSHIP YEARS OF STAY IN PRESENT HOME
 Owned  Company  Living w/ relatives/parents ADDRESS
Email Address
 Mortgaged  Rented at P_____________/mo.
EMPLOYER/BUSINESS NAME (If self-employed) Pag-IBIG EMPLOYER ID NO. EMPLOYER’S CONTACT DETAILS
(Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NO.
Business (Direct Line)
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name
Business (Trunk Line)

Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code
Employer/Business Email Address

OCCUPATION POSITION & DEPARTMENT YEARS IN EMPLOYMENT/ BUSINESS PREFERRED MAILING ADDRESS
 Present Home Address
 Employed
 Employer/Business Address
 Self-Employed
 Permanent Home Address
INDUSTRY
 Accounting  Education & Training  Management  Technology
 Activities of Private Households as  Electricity, Gas and Water Supply  Manufacturing  Transport, Storage and Communications
Employer’s & Undifferentiated Production  Extra-Territorial Organization & Bodies  Media  Travel and Leisure
Activities of Private Households  Financial Services/Intermediation  Mining and Quarrying  Wholesale & Retail Trade; Repair of Motor
 Agriculture, Hunting, Forestry & Fishing  HR/Recruitment  Other Community, Social & Personal Vehicles, Motorcycles, Personal &
 Basic Materials  Health and Social Work; Health and Service Activities Household Goods
 Business Process Outsourcing (BPO) Medical Services  Public Administration & Defense;
 Construction  Life Sciences Compulsory Social Security

SPOUSE’S PERSONAL DATA

LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME Pag-IBIG MID NO./RTN

CITIZENSHIP DATE OF BIRTH (mm/dd/yy) TIN OCCUPATION

 Employed  Self-Employed
EMPLOYER/BUSINESS NAME (If self-employed) Pag-IBIG EMPLOYER ID NO. YEARS IN EMPLOYMENT/ BUSINESS

EMPLOYER/BUSINESS ADDRESS POSITION & DEPARTMENT

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

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

INDUSTRY
 Accounting  Education & Training  Management  Technology
 Activities of Private Households as  Electricity, Gas and Water Supply  Manufacturing  Transport, Storage and Communications
Employer’s & Undifferentiated Production  Extra-Territorial Organization & Bodies  Media  Travel and Leisure
Activities of Private Households  Financial Services/Intermediation  Mining and Quarrying  Wholesale & Retail Trade; Repair of Motor
 Agriculture, Hunting, Forestry & Fishing  HR/Recruitment  Other Community, Social & Personal Vehicles, Motorcycles, Personal &
 Basic Materials  Health and Social Work; Health and Service Activities Household Goods
 Business Process Outsourcing (BPO) Medical Services  Public Administration & Defense;
 Construction  Life Sciences Compulsory Social Security

(V01, 02/2017)
 BANK ACCOUNTS (Indicate your 3 most active)
BANK BRANCH/ADDRESS TYPE OF ACCOUNT ACCOUNT NO. DATE OPENED AVE. BALANCE

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

MORTGAGE RENTAL
LOCATION TYPE OF PROPERTY ACQUISITION COST MARKET VALUE
BALANCE INCOME

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?  Yes  No
If yes, please indicate the creditor’s name, nature, amount involved and due date.
Was your bank account ever closed because of mishandling or issuance of bouncing checks?  Yes  No
If yes, please indicate the bank’s name, nature amount and date.
Have you ever been diagnosed, treated or given medical advice by a physician or other health care provider?  Yes  No
If yes, please indicate the condition/diagnosis.
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.

SOURCE OF Pag-IBIG FUND HOUSING INFORMATION

 TV Ad  Radio Ad  Pag-IBIG Fund Personnel  Flyer/Poster/Brochure  Employer  Newspaper/Magazine Ad
 Website  Agency  Pag-IBIG Fund Branch  Real Estate Developer  Seller of the Property  Others (pls. specify) ____________
CERTIFICATION
I/We express my/our intention to purchase the Pag-IBIG Fund acquired asset as described herein and I/We further agree to purchase the property on
“as is, where is” basis.
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 or its duly authorized representative: 1) to verify necessary information or data (i.e., certificate of employment,
pay slips and income tax return) with the concerned government agencies, any other or third parties including banks and other financial institutions from whom
Pag-IBIG Fund had obtained information; 2) to regularly submit and disclose my/our credit data (as defined under Republic Act No. 9510 and its Implementing
Rules and Regulations) to Credit Information Corporation (CIC) as well as any updates or corrections thereof; 3) to share my/our credit data with other lenders
authorized by the CIC, and credit reporting agencies duly accredited by the CIC; and 4) to send me/us updates about my/our application/account via SMS/text,
email, mail or other available means of communication.
I/We hereby further waive confidentiality rules and laws as applicable to establish correctness, validity, and authenticity of documents that would help
facilitate the processing and evaluation of my/our application.
I/We hereby agree that any misrepresentation of a material fact is a ground for disapproval of the application, cancellation of the purchase 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 application is granted.
I/We further agree to pay Pag-IBIG Fund the corresponding prescribed processing fees for the application.

____________________________________ ____________________________________
SIGNATURE OF BUYER DATE

THIS FORM CAN BE REPRODUCED. NOT FOR SALE.