{ I

HO'\AES
-
T-}
rilfiil-ililfi
4990
TO\ /ERS t- 9990
I

RBA,N
,,
I'EC.A HOMES
89qo
I{OLf)INGS, INC. FOG HORN. INC.
8990 Corl>orate Cerrter. f\fegros St.- Cebrr Elrrsiness Park, Celru Cib,' 6000

CHECKTIST OF REQUIREMENTS

FROM CTS 8AI.IK PAG-IBIG FINANCING

A1. IF EMPTOYED tOCAttY

1. 4 PCS 1xl lD PICTURE BOTH SPOUSES
2. MARRIAGE CONTRACT- if applicable
3. BIRTH CERTIFICATE - if applicable
4. 2 VALID lD'S W 3 SIGNATURE (sss id, tin id, postal id, passport id, drive/s license)
5. NOTARIZED CERTIFICATE OF EMPI.OYMENT WITH DETAILED COMPENSATION (ORICINAL)
6. LATEST 2 MONTHS PAYSLIPS CERTIFIED BY HR/ EMPTOYER
7. BIR FORM 2316 IF APPLICABLE
8. PAG.IBIG TOYATTY CARD PIUS
A2. IF EMPIOYED AEROAD
1. 4 Pcs 1x1 ID PICTURE BOTH SPOUSES
2. MARRIAGE CONTRACT - if applicable
3. BIRTH CERTIFICATE - if applicable
4. 2 VALID lO'S W/ 3 SIGNATURE (sss id, tin id, postal id, passport id, drive/s license)
5. EMPLOYMENT CONTRACT AUTHENTICATED BYTHE EMBASSY
6. IT RENEWAT CERTIFICATION FROM EMPTOYER DUTY AUTHENTICATED
7. V|SA / PASSPORT / TTCKET EX|T & ENTRY
8. SPA DULY NOTARIZED / AUTHENTICATED (original/CONSUtARIZED/RED RIBBON)
9. 2 VALID ID'S OF ATTY-IN-FACT
10. PAG-IBIG LOYATTY CARD PTUS
A3. IF WITH BUSINESS
1. 4PCS 1x1 lO PICTURE BOTH SPOUSES
2. MARRIAGE CONTRACT - if applicable
3. EIRTH CERTIFICATE - if applicable
4. 2 VAI-ID lD'S W/ SIGNATURE (sss id, tin id, postal id, passport id, drive/s license)
5. BUSINESS PERMIT
6. MAYOR'S PERMIT
7, FINANCIAT STATEMENT DULY CERTIFIED BY BIR FOR THE LAST 2 YEARS
8. ITR FOR THE LAST 2 YEARS W/ O.R. PROOF OF PAYMENT FROM BANK/ CERTIFIED BY BIR
9. OR / CR FOR VEHTCTES
10. FRANCHISE LICENSE FOR UV VEHICTES
11. PICTURE OF BUSINESS AND SKETCH TOCATION OF BUSINESS
12. PAG.IBIG TOYALTY CARD PIUS

Please visit our office at 2F Deca Mall, vitas & velasquez st. Tondo, Metro Manila, Monday to Friday 9:oo AM to
5:0O PM; Saturday, Sunday & Holiday 10:00 AM to 4:00 PM and look for MS. ANI{ BAtt yUT.
For inquiries & assistance, list the following contact numbers:

0999-887-8773; 0998-585-3108; 0917-545-0457

We're happy to serve you.

Thank you!
 HOP.HLF468
(v08,02t2020)
HOUS!NG LOAN APPLICATION
Mlo Numb€r/RTN
IHIIIIgIIII IIIIT I
LOAN PARTICULARS
WITH EXISTING HOUSING APPLICATION
PURPOSE OF LOAN
O YES ONO
E Purchase of fully developed residential lot or adjoining residential lots lf yes, indicale Housing Application No
E Purchas€ of a residential house and lot, townhouse or condominium DESIRED LOAN AMOUNT (adusive or DESIRED LOAN TERM (Years)
unit, inclusive of a paaing slot oe clto.rorors @s/6d b6n anoi,nl, ll ony)
E Construction or completion ofa residential unit on a rssidential lot t
E Home improvoment OESIREO RE-PRICING PERIOD (yearls)
tr Refinancing of an existing housing loan o1 03 05 010015 o20 D25 030
E Purchase of residential lot plus cost of transfer of titl€ IIIOOE OF PAYMENT
O Purchaso of residential unit plus cost of transfer of title O Salary d€ductjon O Colleciing Agenl
O Purchass of a parking slot O Over-the-Countor D Bank
O PoslDatod Checks O Developer
O Cash/Chack O Remittance Center
COLLATERAL
PROPERTY LOCATION (St'oet, Municipality, Pmince) TYPE OF PROPERTY
E Rowhou3s E Singlo Detadod E Townhouse
Altachod E Condominium o
NAME OF DEVELOPEFYREGISTEREO TTTLE HOLOER DESCRIPTION OF
EXISTING PROPOSED
IMPROVEMENTS
TCT/OCT/CCT NO. TAX DECLARATION NO, LOT/UNIT NO BLOCIVBLDG NO,
STOREYS
IS PROPERTY PRESENTLY LAND AREIJFLOOR AREA AGE OF HOUSE (ForPurEhase ota TOTAL FLOOR
MORTOCGEO?
OYES O NO AREA
soM soM soM
IS TIIE PROPERTYAN OFFSIE COLLATERAL? O YES O NO NS FOR USE OF OFFSITE COLLATERAL
tf sh€el tor lhs oflsito collateral details
BORROWER'S DATA
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME CITIZENSHIP O Ar E OF B tRf H (hh/dd,ty) sEx
OM OF
PERMANENT HOME AODRESS MARITAL STATUS
l-rrJvRoom No., Flo..
8'rldhg N.iE Lot No., &r No., Ph.!. No.. ltqe ,,1o.
O Sinebrunmaried AITACH HERE
O Manied t"xt"
O Annullod ID PHOTO
f/nirp*lylcit P,ort,r.. .rrl SLi. Cd.iry (r .b@q ZIP Ce O Logally Separated OF APPLICANT
tr Wido*€r
PRESENT HOME ADDRESS BORROWER'S CONTACT OETAILS (rrdlcalo counlry codo
UdVFt@m tlo,, Flo.. Bdkrng tl.lrl. LolNo., abd No., Ph$a No,, tioul. llo.
COUNTRY A AREA COOE TELEPHONE NO.

Munfdp6lrly/Clry PEvinc. fid SLl. ColnLy (r.bt@.l zlP C&

ME OWN iN EE SSS/GSIS lD No.

O owned O Company O uving w/ r€lelivetparcnls SENT I]OME EmailAddress
s
o O R6ol6d at P /mo.
EMPLOYEFyBUSINESS NAME (tt setl4nptoyod) IIN
EMPLOYER S CONTACT OETAILS (/rdarl. cor,,rlry cod.

EMPIOYERiBUSINESS ADORESS OCCUPATION COUI{TRY + ARf:A COOE IELEPHONE NO.

UniuRoon No., Floo. auldn9 rrl Loi ll,o., abd( ib.. REi. No..lloln tlo. 9n ll{€rli O Emplo)€d Ausin6ss (Drr€ct Lins

ltrnldpdvr'oty Awinc. .d sbL cdnliy

O S6r-Employ6d
(r.b@o zlP c&.
I
Blrslrcss (Trunk Lins

INOUSTRY
I
Em EmailAddress
O A..oun{rE tr BurrE$ Pro€$ O'Lourdng O H€allh snd So.ial Wort: tr T€dvrclogy
O Actvlt.r ol PdvlL (BPO) 86aIh and Modcsl SGMcoB tr TrarEpon, $o..gE
tr CoBtruclion tr Llrs Sclon sr .nd conmudc€0orE
PREFERREO TIME TO BE CONTACTED (For
Employ€r'B & tr Educalioo & Trainirlg O Mamgomsnl
tr El6clddty, GaB ard wal6r O Mandactudng E Wnob35l. & R€tall
Employ6r)
Prcdu.{on ,\cllvlllss Supply O M6dla
tr Edr.-Tgniiorial Orlanizalbn a tr Mining and Ou6rrying POSITION & DEPARTMENT YEARS IN
Eodi€3 O Olhor Community, Social & EMPLOYMENT/
O A8dcultulo. Hunling. tr Firtandal Servi€d Ps6onal Ssruico Ac{viligs BUSIN€SS
O Public Admidslralaon O€ians€i t PREFERRED MAILING AOORES NO. OF
O B€rc Malarial. O HR/Rocnilrn€nl Compubory Soclal S6olnry tr Pr6s6nl Hom€ Address DEPENOENT/S
O Employer/Business Address
tr P6rman6nt Horn€ Addr€ss
SPOUSE'S PERSONAL DATA
LAST NAME FIRST NAME NAME EXIENSION MIODLE NAME Pag-lBlG MID NO./RTN

CITIZENSHIP DAIE OF BIRTH {a,r./dd4ry) TIN

EMPLOYER/BUSINESS NAME (II soT4nploy*) YEARS IN EMPLOYMENT/ EUSINESS

EMPLOYER]€USINESS AODRESS OCCUPATION POSITION & DEPARTMENT

UdVR@m No., Floor Building Nem tot No., Bbcr No., PhEs No., Hou6 No. SLet Nem O Employed
O Self-Employed
Muniopality/Cily Ponne end Slet6 Counlry (taD,oa4 ZIP Cod€ BUSINESS TEL. NO.

INDUSTRY
O Accounling
D A.rivitie ol Private HMh.lds
Employr'/a & Udif6r6ntial6d Producli)o
Actvlllo! ol Prlv6lo HorB6hddg
tr A0narll/.o. Hudir€, Fo.63uy A Filaing
O Corlln&ton
tr alls]no33 Proc6$ OGourdng (8PO) trUto Sdorl.€3 tr Tecnnobgy
a tr Educslo.r 8 Tdidng O Mam!€mod O Traospon, Slorago ard
tr El€clidty. Ga! lnd Wal€r Supply O Manuf.cluing
O Exlra-Tsnitofi€l Oeanizauon A Bodh3 tr Modia O Travsl and L6isurs
O FiMmirl Sa0id6/ l.t6lmdirti6 tr Midng 8td Ou.nyi.lg tr wlrolosb a R.hil Irrde
O HfuR€crulrnenl D OttEr Corrnnldty, Sod.l e P.l!o.l.l Sorvcs Actviti€s R€pair oI Moto. V6lid6B,
O ti.slul ard Socirl ltorh D Public A.ll dirdbn t O6t ll!6; Compdlory Sodst Molor.ydos, PoBo.El 6
Health and ti.l€dlcal S€.vlca3 Satrity
 HOP.HLF.O68
.
(v08, 02y2020)

BANK ACCOUNTS (lndicate your 3 most active)

BANK BRANCH/AOORESS TYPE OF ACCOUNT ACCOUNT NO. OATE OPENED AVE. BALAiICE

tl
CREDIT CARDS OWNED (lndicate your 3 most active)
CARO TYPE CARO EXPIRY
ISSUER i{AME CRED]I LIMI'

REAL ESTATE OWNED

MORTGAGE
LOCAIION TYPE OF PROPERTY ACOUtStltot{ COST MARXET VALUE
BALAI{CE
REI{TAL ITICOME

OUTSTANDING CREOITS/LOAN AVAILMENTS

Credilor & Address SBcunly Tvpe Maludty Dale

S6curlty Maiudly Dala

Credilor & Address niy Malurity Date

MISCELLANEOUS
uesl,ons wll, YES or ilo, ,, u answet is YES, please elaborate the details as
Ar€ there past or pending cas6s agaiml you? O Yes O No
tfY amount involved and the slalus
Do you have pasl du6 obligations? 0 Yes NO
tf indic€16 the emounl involvod and du€ dsl6.
was your bank accounl evgr clos6d becal,36 ol mishandling orbsuenco ol bouncing chocks? O ONo Y€s
lf vss. olsas€ indicato lhg bank s nams. naturo amount and dato
Have you ever begn diagnosod, lroated or given mgdical advlc6 by a physician or other health car6 provide, O Yes ONo
ll please indicale lhs condition/diagnosis
LOAN AND CREDIT REFERENCES
BANK/FINANCIAL II.ISTITUTION AOORESS PURPOSE
@
E
g:r{mri? IIIGHEST
AMOUNTOUIED
PRESENT
BALANCE
OATE DATE FULLY
PAIO

TRADE REFERENCES (For Self-Employed Only)

NAI'E OF SUPPLIER AOORESS IEL. NO.

CHARACTER REFERENCES
AOORESS TEL. NO

SELLER'S OATA
LAST NAME FIRST NAME NAME EXTENSION MIDOLE NAME Pag-l8lG MID NO./RTN TIN

unil/Ftom ilo., Fl@. B'Ildng nl.lll Lol lrlo., an tlo-. Pn... l{o.. rho!. tao. ah.t Nrrr CONTACT NUMBER

gib(h, oo 8!.rl9.y l,tmEp.Iy0ty trE in . !n Str Cotlntl (r-ro.4 EMAIL ADDRESS

SOURCE OF Pag-lBlG FUND HOUSING LOAN INFORMATION

O TV Ad El Radto Ad
O PagJBlG Fund
O Fly6r/Po6tor/Brochur6 O Employ6r O Nowspape/Magalne Ad

O websrte O Ag6ncy
O PaelBlG Fund
O Rsal Estato Doveloper O Sellsr of lhe Prcperly O Olhors (pls. specify)
Branch
CERTIFICATION

;c€ssirE sntite;, oursourc€;nilt€! and dat sub,6ct3, in sccorda.E6 wl$ ln6lmplomsnli.rg Rul€s and R€grdations of R6publlc Act No 9510.

li/v€ promis€ lo notily Pag-lBlG Furd ol.ry tmondmonl! o. ch6n96s ln my/our porcorlal into.rnaton indic€led n€rsin.

of my/ou applicatjon including th€ rcl6vanl omploymsnvin om6 intorrlalion thal shsll b6 provldod bv mv/ou omplover.

conraii€d her6ln- t/W€ agr€o th{ att Intorlnstion obtakEd by Pag-lAlG Fund rhall mmdn ils prop€dy wh€ther or not lh€ loan is grdnied.

SIGNATURE OVER PRINTEO NAME OF BORROWER SIGNATURE oVER PRINTED NAME OF SPOUSE

DATE DATE
THIS FORM CAN BE REPRODUCED. NOT FOR SALE
 HEALTH STATEMENT FORM
(MEDICAL QUESTIONNAIREI

IiIAME
ADDRESS
DAIEOFEIRTII
PIA@OFEIRIII
O@UPAIION
II)AI{AMOT'NT

I hereby dedarc and agree that all the staternerrts and answers contained herein are tue, complete and
conect to the best of my hro*{edge and belief and strall form part of my application for MRI insr:rane. It is
understmd and agreed that no MRI insurance cc,verage strall be atrected, unless and urtil this application is
approved and the fril prernium is pald during my orrtinued good healtl:r.

1. Do lou hare or did you hare any of the following during ttrc past 5 lears? CHECK APPROPRIAIE BO)C IF YES,
GIVE DETAILS (can use bad( page):

Yes No
a C.onsulted or been teated by any PhysiJan or other Medical hactitbner for arry disease
pertaining to
(1) brain or nerror:s qretern?
(2) h:ngs or respiratory tract?
(Q heart or bbod rrssels? T
(4) stornadr or arry abdominal organ?
(5) AIDS, AlD$related compler< or AIDS related conditions?
(6) Any brm ofcancer
b. Tested posithre for antibodies to the AIDS vinrs?
c Any accider( injury, surgical cperatior\ hospital confnonen! medical advise or
o<amination other than tlrose merrtioned above?
d Dizzy spells; recurrent dresl badg or abdominal pain, persistort cough; blood in the
urine; blood spitting?
e. Any h:mp o grwuth in arry part of the body or any other phlsical deformity or
abnormality, as impaired hearing or eyesight, lamerress or amputatir:n?
f X-ray, elecfocardiogram (ECG), blood analJrcis or other diagnostic tests?

2. Fo FEMALE oNLY: Are pu nov pregrunt? If prqnan! state hor many rnonths: _ months.
NO
3. Pres€nt HEIGIITandWEIGHI ft/in -YES lbs
lrst vreight in the last 12 morrths? If so, hov much and why? _YES _ NO
4. Areyou to the best ofyour lauwledge in good health and ftee tom any ptrysical deformity? _ yES NO
If NO, give details:

Signature Over Printed Name of the

Proposed Insued / Debtor

AUTI{ORIZA:TION TO ruRMSH MEDIOCL INFORMATION

I authoria arry physician, hosptal, dinig insurance ompany, or ottrer orgarrization, or errts'$r, irstih:tion,
or
poson that has argr records, cr loowledge of me, to give t oddon ptrflippine Ir"";rr* and Reinsr:rance
Brokers, Inc. or its rcprEsentatirc any information with refererrce to fream, irospitafamrl onsultation,
advice,
examinatiorl t€ahnert, disease, or ailmerrl A photo statb copy of his authorizaGn shall be as effectire
and as
valil as the ori8inal This authorization is in connection with my application for MRI insuralce onty.
Done at --- this _ dry of_ 20

funature Over Printed Name ofthe

Proposed Inswed / Debtor

Witness (Print Name & Sign Above)

ffi
HOP.HLF{5a
(v02.02018)
BORROWER'S VAUDATION SHEET (BVS)

NAME OF SORRO/{ER COITAPT DETAII.s:

I.AST }.A'TE FR,SI }|AI'E trA,.E EXIEI€DN raloorr ll^xE

PRESENT HO.{E ADOAESS

u r8oofl lto.. fl6. ai.{,I rlrtll lct No- 6bcl1ll, Ph... Lo.. tloq. tlo.
s!...rr.i..r a.rrlg., r&fCaaLFoly. rDyLrd6llaarc.sr.yfat!.d, TJoC.r!

NAATE OF OEVELOPER

SUEDIVISIO'I/ PRO.,ECT W}TERE UNTT (l TO EE PURCIIASEO

i 3.
Ata you a
Oo you wi5h !o prl.rll
your P.9{BIG hourt[ ban a99[c.lim iLd lhroqgh ths devebpet?
Do yor,l .cccrl tha prgDarty to yor,n ovrr E lsraclioo?
o
o
o
o
o
o
4. Baye you btan lnbmrd aborlt tha tanns.nd conditimr cf your lorn? o o
I h.oby ca.tit thrl th! b.ogoirlg hrofirBtioar.l!.ntc t lo Uua, corrsol .nd co.rglelr. Liksvri9., I cs{fy th.ll have
been rcmindrd by th. $rupdz.d Prg.lElG Rl,ld .rpr...
aliva on P.g-lBl3 polici.r on houalng lorn t*.-oi.*, moD${y
arnonizdion, nDdas o, pryfll.nt snd dlr d.tr, pan8ty nta, arE cons3qtleooa. o, dehut,

Sbnauf. ot Bo]rorvrl olrar Ptlntld Namt

--- Oatc

I thd _____-_--j-vlr
h.obv c.rllrv h3s provento me hblhorldcdity tiuough his/her
haa apDa.rd .nd h.r prnonely ecoolrplirhcd.nd dgoed botoG rl. fia Sorlwlfr Vdidation
ShoGt rog.lrx, rlith tl. !r.n r.d liorierg. Aeracmarf (UfA), D..d ol Ab.olds Srlc (0OAS). Di.doqm Sbtsrrent on
Loan Tr.rE cdon (DSLT).rd O.rd ofcondton l SlL (OCS).

I tunh.r c.r6ry th.t I h.v. y.ri6.d hi.rhor [t!nt m .vrilirt of ttE P.g-l8lg tloulirE Loan. I hayc sbo oxphirled hir hsr
ol th. loUonino:
. Ttl boflou.r is covmd ry r litor$.g. R.dsrptin llEuancq (URly$bs R.ddnption lnsur.ncc (sRl) a.d ur
propqty yilh Firo ln$r.rrc.. Th. con.lpondr{ lmr,nrnca pr.mlun rheu brm prrt 0l tha rnont$y arEJtEatlon.
. Tho hbr.at rara .hdl b. 3ubJ.cl b r.rrichg d.pJdif ori cho.an ra?alc&E Datlod,
. l, th. Dowlop.r h.E E ColLdlon Scrvbir! Agn ]Irrt bor*yet $.u pty dir€ctly
(CSA) wlh Prg-lBlO Fmd, ulc
tra Oov.bDca, o&!ruL. tha bonow.r r ltt pry or{y !o accr.dn d prrkrr benkr or rdhori:ad cou.ctlon
to
partmrs ld3ntiird ln th. Nolb. ot l,lll3urnctUAlmdiz.ton.
. Th. rpplk:lim ot FyrEd .lrd U.dnxd of lrDuna P.ld ln ucota ol lh9 ,aqdr.d mofll y smoilnliotr
. tn c.a. or hllr. ta p.y cn drr. d.r., r g..r.fy.qutr.Ld!o 1/2Oot'l!a o,th. rtFu dt b..v.ry d.y ord.hy rrl.I
. IrffitX.? 3Lffil; mortny enrorrEemm shrt co,.ttl" r dohdl
. h c... ttrr! lr.. bo..r . br..oh h th. \.{tlrytl ud tlr &Y.bPs hb to cotnPl, uith l,hi Nolie? ol Oo6cl.ncy, th..
accour* atn! b. .llbl.d to bt ybrclc
. Ihr eecoqnt rtrl bi oonvcrta tom gfs !o REU noa Lt t$.n 24' tlBrih tom !.lcotn br @urtr.unCa. Wndgyv
'f and Wiflrow 2. o. 3F rrEnlh tom !E d.L o, lorn t l(.od br $cout{. tlrd., \ flndof, I .(E$.). (lri'h/do tth
s!.a!l,!rt o,E t alr. lrotl','tg.p*.bn ls lu,tfu o.v*Er wot CTS W.tfui)
. Tho bororwicrn rvrll of. rub..gusna houtlne lo.4 ploryld.d h.t O h.&tE b an lcfvc ]fl.mbsr of P.g-lBlG Fund
2) Hir ho5bg .ccou.gs Lr.n upd.trd: .nd 3) lto/.h hrr crPldty b P.y hut t oblb.tiorvt'
. li cer. ffr uprlO b. dbdop.r'tq/h. h th. documaaft Cln d, rp.dfc.Iy brlo.n.d[rt.nd.tnorlts thn, he/the
sh.I b. rtqdtd to t!.p9.u prrlon.lly lt PrC'lBle Follc !o tlcalvc rr.!d .lon lhe t-!a{fcd coPy of tha docur 16,*/3.
. E r..t ot rmorD.rtl{p artlr.ton l,. b.rd m ta Dlwrfog gtld.frs et thr timc ol t ltoul
. Ih. p.ylBnl ol nd proprrty br dtrf lh. lorn trt orl rh.ll bo thoddcrcd by th. botro'tlt. Tho olficial rscsipt of
rcrt friporty trx priC tor th. pl.cadirE ylar.h.[ !c &Ur{tt d to P.g-lBlO Fud ]pt l.ts lhan Junci3o ol th.
.' cur6rr icer.eno rvrry y.., lh.r..lLt Th.-p.ytll3r{.o, ttd PPPctty tu b an oblorlon lrnpoe.d by Soolionr
2.15 io 25O of Rcpubtic Acr No. 71e0, hown .. th. t!o.l Golrmm.nt Code ot 1S'1. Frilur. to pry on tm. will
b! r e rqmd br th. Mmwalry/,(r,,ry d ttl,@4g.IMw&Mb lmPo3s.n lnlor..l P6f mon0r cl ths roalty
tax du., and b sall your prcplrty to l.lta your la dalhquancl.
. tn ca.. ottll payrn nt. tha LxGs rnd otl.r cod brfarLbr otffe tom PaC-lBlG Fund h bonowrr shall be for
th. l.[.t'. acciunt. pnc,oar aly'8 {/oalf, t orty ! tT nottrhg fzph.tiba is ird.r O.vc.bFr wlh DCs
Doc.Jrno,l,.t/otl)

Sco.un! ol Pre{Bl6 Fund'r ArlhorLctl Phca Yltrr. YaliCrton m. h.ld

Rapr.aJt lY. Ov.r Pdrlbd N.m. DrL:

-
 LETTER OF CONSENT

Dear 5ir/Ma'am:

This is to give my express consent for you or your authorized representative to disclose my employment
information and compensation details to pag-tBl6 Fund during their credit, backgrouni and
employment investigation activities, rerative to my housing loan application with them.

Thus, kindly accommodate their inquiries on the said matter, either through email,
telephone or
employer visitation, and provide them any information needed for the validation of my
employtnent and
compensation.

I hold my employer, free from any

liabilities and damages that may cause me by virtue of this letter of conrent and I
am assuming full
responsibility on the effects of this to me.

Thank you.

Very truly yours,

Employee

Received by:

Company Representative
Republic of the Philippines )
)

AFFIDAVIT OF UNDERTAKING

t, of
legal age
-(Cul
Stetus) and resident of

,.,,r, after having been duly swom to in accordance with law do hereby
depose and say that:

1. I am the buyer ol the housing/condominium unit identified as

(Btock anLl WhiCh I
trt/Buitdins ontl unit Nuntut, r,"r".9,
have purchased from the owner/developer ("Developer") through the
latter's in-house financing scheme;

2. Upon my request, the Developer allowed me to apply for a housing loan application with Home
Development Mutual Fund ("Pag-IBIG Fund"), in order that my total outstanding obligations with the
Developer pertaining to my purchase of the abovementioned housing/condominium unit would be fully
paid;

3. I am aware and I fully consent to pay the amount equivalent to six percent (6%) of my total outstanding
obligations (TOO) with the Developer, which shall answer for all costs and expenses necessary in
processing my application with Pag-IBIG Fund;

4. All the facts and information I stated, declared, disclosed and provided relative to my loan application
with PagJBIG Fund are true and correct of my personal knowledge and/or based on authentic records;

5. In the event that my application with Pag-IBIG Fund is denied by reason of falsity of any facts or
information, or fraudulent omission of information, or due to my refusal to continue to comply with the
other requirements of the Pag-IBIG Fund without justifiable reason, I shall be liable to pay all costs and
expenses above mentioned as well as any and all expenses necessary to restore the property to its
condition prior to the loan application with Pag-IBIG Fund, including but not limited to, the cancellation
of annotations on the transfer certificate of title/condominium certificate of title covering the said
housing/condominium unit, or the reversion of the property to the name of the Developer;

IN WITNESS WHEREOF, I have hereunto affixed my signature this duy of

at Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me this _ day of affiant exhibitins

to me his/her

Doc No.
Page No.
Book No.
Series of
-