For Pambansang Pabahay Para sa Pilipino (4PH) HQP-HLF-1035

(V01, 11/2023)
4PH HOUSING LOAN APPLICATION
Pag-IBIG MID Number/RTN

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

LOAN PARTICULARS
DESIRED LOAN AMOUNT (Exclusive of the co- DESIRED LOAN TERM (Years) MODE OF PAYMENT
borrower’s desired loan amount, if any)  Salary deduction  Collecting Agent
 Over-the-Counter  Bank
 Post-Dated Checks  Developer
 Cash/Check  Remittance Center
COLLATERAL
PROPERTY LOCATION (Street, Municipality, Province) TYPE OF PROPERTY
 Rowhouse  Single Detached  Townhouse
 Single Attached  Condominium  Duplex
NAME OF PROJECT PROPONENT/REGISTERED TITLE HOLDER TCT/OCT/CCT NO. TAX DECLARATION NO. LOT/ BLOCK/ LAND AREA/
UNIT NO. BLDG NO. FLOOR AREA
______SQM
BORROWER-BENEFICIARY’S DATA
LAST NAME FIRST NAME NAME EXTENSION (if applicable) MIDDLE NAME CITIZENSHIP DATE OF BIRTH (mm/dd/yy) SEX
M F
PERMANENT HOME ADDRESS MARITAL STATUS
Unit/Room No., Floor Building Name Lot No., Blk No., Phase No., House No. Street Name  Single/Unmarried ATTACH HERE
 Married 1”X1”
 Annulled ID PHOTO
Subdivision Barangay Municipality/City Province and State Country (if abroad) ZIP Code
 Legally Separated OF APPLICANT
 Widow/er

PRESENT HOME ADDRESS BORROWER’S CONTACT DETAILS (Indicate country code

Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name 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 EE SSS/GSIS ID No.

 Company  Living w/ relatives/parents PRESENT HOME Email Address
ADDRESS
 Rented at P__________/mo.
EMPLOYER/BUSINESS NAME (If self-employed) TIN
EMPLOYER’S CONTACT DETAILS (Indicate country code
if abroad)
EMPLOYER/BUSINESS ADDRESS OCCUPATION COUNTRY + AREA CODE TELEPHONE NO.
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name  Employed Business (Direct Line)
 Self-Employed
Subdivision Barangay Municipality/City Province and State Country (if abroad) ZIP Code Business (Trunk Line)

Employer/Business Email Address

INDUSTRY
 Accounting  Business Process Outsourcing  Health and Social Work;  Technology
 Activities of Private (BPO) Health and Medical Services  Transport, Storage PREFERRED TIME TO BE CONTACTED (For
Households as  Construction  Life Sciences and Communications Employer)
Employer’s &  Education & Training  Management  Travel and Leisure
Undifferentiated  Electricity, Gas and Water  Manufacturing  Wholesale & Retail POSITION & DEPARTMENT YEARS IN
Production Activities Supply  Media Trade; Repair of EMPLOYMENT/
of Private  Extra-Territorial Organization &  Mining and Quarrying Motor Vehicles, BUSINESS
Households Bodies  Other Community, Social & Motorcycles, PREFERRED MAILING ADDRESS NO. OF
 Agriculture, Hunting,  Financial Services/ Personal Service Activities Personal &
 Present Home Address DEPENDENT/S
Forestry & Fishing Intermediation  Public Administration & Defense; Household Goods
 Basic Materials  HR/Recruitment Compulsory Social Security  Employer/Business Address
 Permanent Home Address
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

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

EMPLOYER/BUSINESS ADDRESS OCCUPATION POSITION & DEPARTMENT

Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name  Employed
 Self-Employed
Subdivision Barangay Municipality/City Province and State Country (if abroad) ZIP Code BUSINESS TEL. NO.

INDUSTRY
 Accounting  Business Process Outsourcing (BPO)  Life Sciences  Technology
 Activities of Private Households as  Education & Training  Management  Transport, Storage and
Employer’s & Undifferentiated  Electricity, Gas and Water Supply  Manufacturing Communications
Production Activities of Private  Extra-Territorial Organization & Bodies  Media  Travel and Leisure
Households  Financial Services/ Intermediation  Mining and Quarrying  Wholesale & Retail Trade;
 Agriculture, Hunting, Forestry &  HR/Recruitment  Other Community, Social & Personal Service Activities Repair of Motor Vehicles,
Fishing  Health and Social Work;  Public Administration & Defense; Compulsory Social Motorcycles, Personal &
 Basic Materials Health and Medical Services Security Household Goods
 Construction
BANK ACCOUNTS (Indicate your 3 most active)
BANK BRANCH/ADDRESS TYPE OF ACCOUNT ACCOUNT NO. DATE OPENED AVE. BALANCE
 HQP-HLF-1035
(V01, 11/2023)

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

LOCATION TYPE OF PROPERTY ACQUISITION CCOST MARKET VALUE MORTGAGE RENTAL
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 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 FULLY
BANK/FINANCIAL INSTITUTION ADDRESS PURPOSE SECURITY
AMOUNT OWED BALANCE OBTAINED 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 above my/our printed name/names below is/are
genuine.

I/We authorize 1) Pag-IBIG Fund or its duly authorized representative to verify necessary information or data (i.e., certificate of employment, pay slips and income tax return) with the
concerned government agencies or third parties including banks and other financial institutions from whom Pag-IBIG Fund had obtained information; 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; and to send me/us
updates about my/our housing loan application/account via SMS/text, email, mail or other available means of communication; and 2) CIC to share my/our credit data with accessing entities, special
accessing entities, outsource entities and data subjects, in accordance with the Implementing Rules and Regulations of Republic Act No. 9510.

I/We authorize Pag-IBIG Fund to share my/our personal information and other details of my/our loan account with other government agencies and third parties, as may be necessary in the
management of my/our account/s and for collection purposes, subject to the limits under Republic Act No. 10173 (Data Privacy Act of 2012), and its Implementing Rules and Regulations. Further,
I/we promise to notify Pag-IBIG Fund of any amendments or changes in my/our personal information indicated herein.

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 including the relevant employment/income information that shall be provided by my/our employer.

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 Fund 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 be bound by the current and general policies of Pag-IBIG Fund and those that the Pag-IBIG Fund may adopt in the future, that may have relation to or in any way affect
my/our loan.

I/We understand that the processing/service/filing fee, notarial and all other fees pertaining to the registration of mortgage on property shall be for my/our account.

I/We am/are aware that I/we am/are obliged to pay for the interest subsidy and/or amortization support if the said dues are not remitted and/or terminated; otherwise, my/our housing account
will be in arrears and shall be charged with applicable penalty until it is paid.

_____________________________________________ _________________________________________
SIGNATURE OVER PRINTED NAME OF BORROWER-BENEFICIARY SIGNATURE OVER PRINTED NAME OF SPOUSE
____________________________________ ____________________________________
DATE DATE
THIS FORM CAN BE REPRODUCED. NOT FOR SALE.