Pag -IBIG ID : Member : * Last Name * First Name Name Ext. (e.g.

JR, III, IV, V) * Middle Name No Middle Name (Check if Applicable Only) Check if Same as Above Member's Name : (As Appearing in the Birth Certificate) * Last Name * First Name Name Ext. (e.g. JR, III, IV, V) * Middle Name No Middle Name (Check if Applicable Only) Father Mother (Maiden Name) Last Name : First Name : Name Extension : (e.g. JR, III, IV, V) Middle Name : No Middle Name (Check if applicable only) * Last Name : * First Name : Name Extension : (e.g. JR, III, IV, V) * Middle Name : No Middle Name (Check if applicable only) * Date Of Birth : - Month- - Day- -Year* Place of Birth : Check here if born outside the Philippines [Select Region] [Select Province] [Select City/Municipality] * Gender : Male Female T.I.N. : * Citizenship : Filipino * Civil Status : [ Select ] Spouse (Maiden Name if Applicable) * Last Name : NA NA * First Name : NA NA

Name Extension : (e.g. JR, III, IV, V) NA NA * Middle Name : NA NA No Middle Name (Check if applicable only) Page 1 of 5 HDMF Online Registration System 8/16/2011 http://www.pagibigfund.gov.ph/PubReg/MemberRegistration/Registration2.aspx?REGOP ...

SSS ID No. : GSIS ID No. : Leave this blank if GSIS ID No. is not 11 digits. Common Reference No. (CRN) (If available) : Place Of Birth is required. Prominent Distinguishing Facial Feature : * Permanent Address [Select Region] [Select Province] [Select City/Municipality] Unit/Floor/ Room No. Building Block No. Lot No. Phase No. House No. Street Subdivision Barangay City/Municipality Province * Zip Code Click here to preview Address Display * Present Address Check if Same as above Check if Abroad [Select Region] [Select Province] [Select City/Municipality] Unit/Floor/ Room No. Building Block No. Lot No. Phase No. House No. Street Subdivision Barangay City/Municipality Province * Zip Code Click here to preview Address Display Zipcode is required. * Email Address : * Preferred Mailing Address : Present Home Address Permanent Home Address Employer/Business Address Contact Numbers (Indicate country code if abroad) Home :

Page 2 of 5 HDMF Online Registration System 8/16/2011 http://www.pagibigfund.gov.ph/PubReg/MemberRegistration/Registration2.aspx?REGOP ...

Country code Philippines (+ 63 ) Area Code Telephone Number Cellphone : Country code Philippines (+ 63 ) Prefix (0918, 0915,etc) Cellphone No. Business (Direct Line) : Country code Philippines (+ 63 ) Area Code Direct Line Business (Trunk Line) : Country code Philippines (+ 63 ) Area Code Trunk Line Local No. Beneficiaries (In case of death, Fund benefits shall be divided among the member's legal heirs in accordance with the New Civil Code as amended by the New Family Code) No. 1 Relationship [Select] Date of Birth - Month- - Day- -Year- Last Name First Name Name Extension Middle Name No Middle Name (Check if Applicable Only) No. 2 Relationship [Select] Date of Birth - Month- - Day- -Year- Last Name First Name Name Extension Middle Name No Middle Name (Check if Applicable Only) No. 3 Relationship [Select] Date of Birth - Month- - Day- -Year- Last Name First Name Name Extension Middle Name No Middle Name (Check if Applicable Only) No. 4 Relationship [Select] Date of Birth - Month- - Day- -Year- Last Name First Name Name Extension Middle Name No Middle Name (Check if Applicable Only) No. 5 Relationship [Select] Date of Birth - Month- - Day- -Year- Last Name First Name Name Extension Middle Name No Middle Name (Check if Applicable Only) No. 6 Relationship [Select] Date of Birth - Month- - Day- -Year- Last Name First Name Name Extension Middle Name No Middle Name (Check if Applicable Only) Membership Category

Page 3 of 5 HDMF Online Registration System 8/16/2011 http://www.pagibigfund.gov.ph/PubReg/MemberRegistration/Registration2.aspx?REGOP ...

* Select Category : [SELECT CATEGORY] Employment History Employer No. 1 Company Name : Employed From : - Month- -Year- To : - Month- -Year- Present Address : Employer No. 2 Company Name : Employed From : - Month- -Year- To : - Month- -Year- Present Address : Employer No. 3 Company Name : Employed From : - Month- -Year- To : - Month- -Year- Present Address : Employer No. 4 Company Name : Employed From : - Month- -Year- To : - Month- -Year- Present Address : Employer No. 5 Company Name : Employed From : - Month- -Year- To : - Month- -Year- Present Address : Employer No. 6 Company Name : Employed From : - Month- -Year- To : - Month- -Year- Present Address : By clicking the Submit button below, I certify that the information given above and all the statements made herein are true and correct. << Back Submit >> Page 4 of 5 HDMF Online Registration System 8/16/2011 http://www.pagibigfund.gov.ph/PubReg/MemberRegistration/Registration2.aspx?REGOP ...

The Successful Registration page shall indicate that the registration process was completed. Page

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