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FLH020

FLH020

MEMBERSHIP STATUS VERIFICATION SLIP
Date Filed: Last Name Home Address Company/Employer/Business Name Company/Employer/Business Address Status
Single Married Widow/er

MEMBERSHIP STATUS VERIFICATION SLIP
Date Filed: Last Name Home Address Company/Employer/Business Name Company/Employer/Business Address Status First Name MSVS No. Middle Name Maiden Name

MSVS No. First Name Middle Name
(For married women)

Maiden Name

(For married women)

Tel. No. Employer ID No. Tel. No.

Tel. No. Employer ID No. Tel. No.

Legally Separated

Annulled

Single

Married

Widow/er

Legally Separated

Annulled

For AFP Employee For DECS Employee

Branch of Service Division Code Station Code

Serial/Account No. Employee No.

For AFP Employee For DECS Employee

Branch of Service Division Code Station Code

Serial/Account No. Employee No.

LOAN PURPOSE Additional Loan Home Improvement House Construction Purchase of a Fully Developed Lot Purchase of Lot and Construction of a Residential Unit Purchase of Pag-IBIG acquired properties Purchase of a Residential Unit Purchase of Townhouse and Condominium Unit, inclusive of parking slot Refinancing of an existing mortgage loan FROM (Mo./Yr.) TO (Mo./Yr.) Additional Loan Home Improvement House Construction

LOAN PURPOSE Purchase of Pag-IBIG acquired properties Purchase of a Residential Unit Purchase of Townhouse and Condominium Unit, inclusive of parking slot Refinancing of an existing mortgage loan FROM (Mo./Yr.) T O (Mo./Yr.)

Purchase of a Fully Developed Lot Purchase of Lot and Construction of a Residential Unit

EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP
NAME OF EMPLOYER/ADDRESS

EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP
NAME OF EMPLOYER/ADDRESS

Member's Signature

Member's Signature

FOR Pag-IBIG FUND USE ONLY
COUNSELLED/PRE-QUALIFIED BY (Counseling Section/Servicing
Section)

FOR Pag-IBIG FUND USE ONLY
Date
COUNSELLED/PRE-QUALIFIED BY (Counseling Section/Servicing
Section)

Date

With Without CLAIMS MPL HL/LP/HI Pag-IBIG Loan as of

Verified by

Remarks CLAIMS MPL HL/LP/HI

With Without Verified by

Remarks

Pag-IBIG Loan as of Total No. of Contributions LATEST CONTRIBUTION RECORD Month/Year PFR No./Date Maximum Allowable Rate (MAR) Loan Entitlement
For Servicing Department/Section

LATEST CONTRIBUTION RECORD Month/Year PFR No./Date Maximum Allowable Rate (MAR) Verified by Date

Amount

Amount

Total No. of Contributions

Verified by

Date

Loan Entitlement
For Servicing Department/Section

For Provident Benefits Division

For Provident Benefits Division

Certified by Remarks

Date

Certified by Remarks

Date

Certified by Remarks

Date

Certified by Remarks

Date

Attachments
Certificate of Remittance Latest Payslip

Attachments
Certificate of Remittance Latest Payslip