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HQP-PFF-093

(V04, 01/2019)

REQUEST FOR CONSOLIDATION/


MERGING OF MEMBER’S RECORDS

________________
Date

Dear Sir/Madam:

I would like to request for the consolidation/merging of my membership records with the
following information:

Pag-IBIG MID Number : ________________________________________________


Member’s Name : ________________________________________________
Last Name First Name Name Extension Middle Name
Present Home Address : ________________________________________________
________________________________________________
________________________________________________
Marital Status : • Single/Unmarried • Widow/er • Annulled
• Married • Legally Separated
Contact Number : ________________________________________________
Employer/Business Name : JPMorgan Chase %DQN N.A. - Philippine Global Service Center
________________________________________________
Employer/Business Address : 3HQWKRXVH)LYH1HR%XLOGLQJVW6WUHHW%RQLIDFLR*OREDO&LW\7DJXLJ&LW\
: 
________________________________________________
Employer/Business Contact No. : ________________________________________________
908 - 5000
Purpose of Consolidation/Merging : • Short-Term Loan (STL) Application
• Application for Provident Benefits Claim
• Others, please specify _________________________________

Previous Employer/Business Name Previous Employer/Business Address Inclusive Date(s)


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Makati 1 Branch
Requesting Pag-IBIG Fund Branch: ______________________________

Requested by: Processed by:

_______________________________ __________________________________
Member’s Name and Signature Name and Designation of Authorized Signatory

Approved by:

__________________________________
Name and Designation of Authorized Signatory
HQP-PFF-093
(V04, 01/2019)

REQUEST FOR CONSOLIDATION/


MERGING OF MEMBER’S RECORDS

________________
Date

Dear Sir/Madam:

I would like to request for the consolidation/merging of my membership records with the
following information:

Pag-IBIG MID Number : ________________________________________________


Member’s Name : ________________________________________________
Last Name First Name Name Extension Middle Name
Present Home Address : ________________________________________________
________________________________________________
________________________________________________
Marital Status : • Single/Unmarried • Widow/er • Annulled
• Married • Legally Separated
Contact Number : ________________________________________________
Employer/Business Name : JPMorgan Chase %DQN N.A. - Philippine Global Service Center
________________________________________________
Employer/Business Address : 3HQWKRXVH)LYH1HR%XLOGLQJVW6WUHHW%RQLIDFLR*OREDO&LW\7DJXLJ&LW\
: 
________________________________________________
Employer/Business Contact No. : ________________________________________________
908 - 5000
Purpose of Consolidation/Merging : • Short-Term Loan (STL) Application
• Application for Provident Benefits Claim
• Others, please specify _________________________________

Previous Employer/Business Name Previous Employer/Business Address Inclusive Date(s)


1.
2.
3.
4.
5.

Makati 1 Branch
Requesting Pag-IBIG Fund Branch: ______________________________

Requested by: Processed by:

_______________________________ __________________________________
Member’s Name and Signature Name and Designation of Authorized Signatory

Approved by:

__________________________________
Name and Designation of Authorized Signatory