LAND BANK OF THE PHILIPPINES

REQUEST FOR CHANGE IN INFORMATION/UPDATING OF RECORDS

Last Name First Name Middle Name M.I. Nickname Date of Filing

Department/Unit LBP Entry PG ID No.

Citizenship (if holder of dual citizenship, please indicate the details) Blood Type
Filipino Dual Citizenship Please indicate country:___________________
GSIS ID No. Pag-Ibig ID No. Are you a Senior Citizen?
Please indicate ID No.
PhilHealth No. TIN No.

Instruction: Please write/print legibly and use additional sheets if necessary. For fields without update/change, please indicate N/A.
A. Change in Civil Status (Put √ if applicable)
Single to Married Married to Separated Annulled Widowed Others ____________________
(NEW) Last Name First Name Date of Change of Status
Middle Name M.I.

Spouse Details
Last Name First Name Date of Birth
Middle Name M.I.
Is Spouse an LBP Employee?
Yes No
Current Employment Status of Spouse (please indicate N/A if not applicable):
1. Name of Current Employer:__________________
Government Sector Private Sector Others:_________
2. Current Position: _______________________
3. Date of Employment: ________________
Plesae update the records whenever your spouse has been transferred/no longer connected with this Company/Institution
Requirements: For Change in Civil Status
 One (1) copy of marriage contract with Registry No. or Court Order – Certified True Copy by the Head of
Department/Branch/Lending, etc.
 One (1) copy of spouse birth certificate – Certified True Copy by the Head of Department/Branch/Lending, etc.
 Duly accomplished forms for MABP/LDBP together with supporting documents.
 If Change of Civil Status is due to Annulment or Declaration of Nullity:
 One (1) copy of Marriage Contract to be Null and Void – Certified True Copy by the Head of Department/Branch/Lending, etc.
 One (1) copy of Certificate of Finality – Certified True Copy by the Head of Department/Branch/Lending, etc.
 One (1) copy of Declaration of Nullity of Marriage – Certified True Copy by the Head of Department/Branch/Lending, etc.
 If Change of Civil Status is Widowed:
 One (1) copy of PSA Death Certificate of Spouse – Certified True Copy by the Head of Department/Branch/Lending, etc.

B. Change in Permanent Address

From: Current: Zip Code: Region:

C. Change in Mailing Address

From: Current: Zip Code: Region:

D. Correction of Middle Name

From: Current:
Requirement:
 One (1) copy of Birth Certificate from Philippine Statistic Authority (PSA) – Certified True Copy by the Head of
Department/Branch/Lending, etc.

E. Correction of Birthdate
From: Original:
Requirement:
 One (1) copy of Birth Certificate from Philippine Statistic Authority (PSA) – Certified True Copy by the Head of
Department/Branch/Lending, etc.
F. Correction of Birth Place
From: Original:
Requirement:
 One (1) copy of Birth Certificate from Philippine Statistic Authority (PSA) – Certified True Copy by the Head of
Department/Branch/Lending, etc.

G. Personal Contact details:

Landline Number: Mobile Number: Email Address:

H. Educational Attainment (Graduate Studies, Post Graduate Studies, etc.)

Name of School Degree/Course Academic Honors Received

Requirements:
 One (1) copy of Diploma – Certified True Copy by the Head of Department/Branch/Lending, etc.
 One (1) copy of Transcript of Record – Certified True Copy by the Head of Department/Branch/Lending, etc.
 One (1) copy of Certificate of Graduation – Certified True Copy by the Head of Department/Branch/Lending, etc.

I. Eligibility/License Acquired
Eligibility/License Eligibility Year/s Acquired Place of Issuance
Rating/License Number

Requirements:
 One (1) copy of Certificate of Eligibility/Rate Certification – Certified True Copy by the Head of Department/Branch/Lending, etc.
 One (1) copy of License – Certified True Copy by the Head of Department/Branch/Lending, etc.

J. Addition/Deletion of Dependents
Name Date of Birth Remarks (Addition or Deletion)
1.
2.
3.
Requirements: For Additional Dependent
 One (1) fully accomplished Mutual Aid Benefit Program/Loss of Life and Disability Benefit Plan Membership & Designation of
Dependents/Beneficiaries Form with complete attachments (i.e., copy of Child’s Birth Certificate from PSA – Certified True Copy by
the Head of Department/Branch/Lending, etc.)

K. Pursuant to: (a) Indigenous People’s Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c) Solo Parents Welfare
Act of 2000 (RA 8972), please answer the following items:

K.1. Are you a member of any indigenous group? ___ YES ___ NO
If YES, please specify: _______________________________________

K.2. Are you a person with disability? ___ YES ___ NO

If YES, please specify (i.e. ID No.): _______________________________________

K.3. Are you a solo parent? ___ YES ___ NO

If YES, please specify (i.e. ID No.): _______________________________________

L. UPDATING OF PERSONAL INFORMATION/RECORDS TO OTHER GOVERNMENT AGENCIES

L.1. Government Service Insurance System (GSIS)
Head Office - Rank & File  Kindly coordinate to Administrative Account Department (AAD) – Payroll Division
Field Units – Rank & File  Kindly coordinate to your Accounting Center
TMG Personnel (R&F and  Kindly coordinate to Personnel Administration Department – Centralized Officers
Officer); Payroll Unit
Head Office & Field Units –
Officers

L.2. Home Development Mutual Fund (PagIBIG)

 Kindly download the latest form/s (pagibig.gov.ph) – Member’s Change of Information; and Members Data Form.
  You may file your updating of information/records together with the supporting documents required thru your nearest
PagIBIG Branch; or if thru Liaison Officer, kindly submit the hard copies of accomplished forms together with the
supporting documents and copy of 2 valid IDs

L.3. Philippine Health Insurance Corporation (PhilHealth)

 Kindly download the latest form (philhealth.gov.ph) – Member Registration Form
 You may file your updating of information/records together with the supporting documents required thru your nearest
PhilHealth Branch; or if thru Liaison Officer, kindly submit the hard copies of accomplished forms together with the
supporting documents

L.4. Bureau of Internal Revenue (BIR)

 Kindly download the latest form (bir.gov.ph) – BIR Form 1905
 Kindly file your updating of information/records together with the supporting documents required thru your Revenue
District Office (RDO)

M. In Case of Emergency:
Name
Relationship with the LBP Employee
Address
Contact No.
Alternative No.
Note:
If the Discrepancy is in the Name, Date/Place of Birth as appearing in the Report of Rating or Certificate of Eligibility, Appointment,
Service Card and the Entries in the Personal Data Sheet, an LBP Employee should submit a copy of CSC Resolution or Order issued by the
Commission/CSC Regional Office (CSCRO) concerned to Personnel Administration Department (PAD) correcting any discrepancy.

I certify that the above information are true and correct to the best of my knowledge. I further declare for item A, that my spouse and
I are not related to any employee of the Bank up to 3 rd degree of affinity/consanguinity, that my spouse is not an agency-hired
contractual/daily paid employee of the Bank, and that any untruthful statement herein may subject me to disciplinary action and
criminal liability.

____________________________________ ________________________________________
Signature of Claimant Signature of Spouse
Noted by: Approved by::

_______________________________________________ ____Teresita C. Rodis___

Department Head’s Signature Over Printed Name/ Assistant Department Manager
Head, HRISAU/Personnel Administration Department

Distribution: Copy 1 – PAD/201 FILE Copy 2 – Receiving Copy