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HQP-HLF-068

HOUSING LOAN APPLICATION


Pag-IBIG MID Number/RTN

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

LOAN PARTICULARS
DESIRED LOAN AMOUNT
PURPOSE OF LOAN
 Purchase of Fully Developed Lot or Adjoining Lots  Purchase of a Residential Unit with Home
 Purchase of Fully Developed Lot and Construction of Improvement DESIRED LOAN TERM (Years)
a Residential Unit  Refinancing of an Existing Mortgage with
 Purchase of Pag-IBIG Fund Acquired Properties Home Improvement DESIRED RE-PRICING PERIOD (Years)
 Purchase of a Residential Unit (House & Lot)  Refinancing of an Existing Mortgage with Construction  3  5  10  15
 Purchase of Townhouse or Condominium Unit of a Residential Unit MODE OF PAYMENT
 Purchase of Townhouse or Condominium Unit  Additional Loan: House Construction  Salary deduction  Collecting Agent
inclusive of a parking slot  Additional Loan: Home Improvement  Over-the-Counter  Bank
 Post-Dated  Developer
 Purchase of Adjoining Property  Additional Loan: Purchase of Adjacent Property Checks  Remittance
 Refinancing of an Existing Mortgage Loan  Additional Loan: Purchase of Parking Lot (for vertical  Cash/Check Center
 House Construction development)
 Home Improvement
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 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

YEARS OF STAY IN
Cell Phone
HOME OWNERSHIP 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 OCCUPATION
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name  Employed COUNTRY + AREA CODE TELEPHONE NO.
 Self-Employed 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
POSITION & DEPARTMENT
Employers &  Electricity, Gas and  Management  Travel and Leisure
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 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  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

(Revised/August 2012)
GROSS MONTHLY INCOME
PARTICULARS PRINCIPAL BORROWER SPOUSE
BASIC MONTHLY COMPENSATION
COST OF LIVING ALLOWANCE
OTHER SOURCE/S
TOTAL

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
LOCATION TYPE OF PROPERTY ACQUISITION COST MARKET VALUE RENTAL INCOME
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.

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