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 Legally Separated Annulled

MEMBERSHIP STATUS VERIFICATION SLIP

Date Filed: __________ Last Name Home Address Company/Employer/Business Name Company/Employer/Business Address Status
Single Married Widow/er Legally Separated Annulled

MSVS No. ______________ First Name Middle Name Maiden Name Tel. No. Employer ID No. Tel. No.
(For married women)

MSVS No. ______________ First Name Middle Name Maiden Name Tel. No. Employer ID No. Tel. No.
(For married women)

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.) TO (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) Date

FOR Pag-IBIG FUND USE ONLY

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

Date

Certified by

Date

Certified by

Date

Certified by

Date

Remarks

Remarks

Remarks

Remarks

Attachments
Certificate of Remittance Latest Payslip

Attachments
Certificate of Remittance Latest Payslip