FPF090
MEMBER’S DATA
FORM (MDF)
MEMBERSHIP CATEGORY
MANDATORY VOLUNTARY
EMPLOYED PRIVATE OVERSEAS FILIPINO WORKER (OFW) EMPLOYED
EMPLOYED GOVERNMENT SELF-EMPLOYED (SE) INDIVIDUAL PAYOR (IP)
EMPLOYED PRIVATE HOUSEHOLD OTHER WORKING GROUP (OWG) OTHER WORKING GROUP (OWG, if income is less than
P1,000.00)
NAME
NO MIDDLE NAME
LAST NAME FIRST NAME EXTENSION MIDDLE NAME
(check if applicable only)
(e.g. Jr., II)
MEMBER
FATHER
MOTHER (Maiden Name)
SPOUSE (If Married)
MEMBER’S NAME AS
APPEARING IN THE
BIRTH CERTIFICATE
DATE OF BIRTH MARITAL STATUS TAXPAYERS IDENTIFICATION NUMBER (TIN)
Single/Unmarried Widow/er Annulled
m m d d y y y y
Married Legally Separated
SSS/GSIS NUMBER
PLACE OF BIRTH (City/Municipality/Province/Country) CITIZENSHIP
(Please indicate country if born outside the Philippines)
EMPLOYEE NUMBER
SEX HEIGHT WEIGHT PROMINENT DISTINGUISHING FACIAL FEATURES
Male (Ex. Moles, Scars, etc.)
Female (m) (kg) For AFP/PNP Employee, Serial/Badge No.
COMMON REFERENCE NUMBER (CRN) FREQUENCY OF MC PAYMENT
(If Available) (If payment of contribution is not thru payroll deduction)
For DepEd Employee, Division Code-Station Code
Monthly Semi-Annually
Quarterly
ADDRESS AND CONTACT DETAILS
PRESENT HOME ADDRESS (Indicate country code if abroad)
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name Subdivision COUNTRY + AREA CODE TELEPHONE NUMBER
Home
Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
Cell Phone
PERMANENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name Subdivision
Business (Direct Line)
Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
Business (Trunk Line) Local
PREFERRED MAILING ADDRESS Email Address
Present Home Address Permanent Home Address Employer/Business Address
(Revised 03/2011)
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
PRESENT EMPLOYMENT DETAILS (If with more than one (1) employer, use separate sheet and follow format below)
EMPLOYER/BUSINESS NAME MONTHLY INCOME
Basic
+
EMPLOYER/BUSINESS ADDRESS Allowances/Others
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No.
=
Total Mo. Income
Street Name Subdivision Barangay TYPE OF WORK (For OFWs only)
Land-based Sea-based
Municipality/City Province State/Country (If abroad) ZIP Code OFFICE ASSIGNMENT
Head Office Branch
OCCUPATION EMPLOYMENT STATUS FROM TO
Permanent/Regular Contractual
Casual Project-based
Part-time/Temporary m m y y y y m m y y y y
PREVIOUS EMPLOYMENT FROM DATE OF HDMF MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
Head Office Branch
EMPLOYER/BUSINESS ADDRESS FROM TO
m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
Head Office Branch
EMPLOYER/BUSINESS ADDRESS FROM TO
m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
Head Office Branch
EMPLOYER/BUSINESS ADDRESS FROM TO
m m y y y y + m m y y y y
BENEFICIARIES (In case of death, Fund benefits shall be divided among the member’s legal heirs in accordance with the New Civil Code as amended by the New Family Code) (Use another sheet if necessary)
NAME NO MIDDLE NAME
LAST NAME FIRST NAME MIDDLE NAME RELATIONSHIP DATE OF BIRTH
EXTENSION (Check only if applicable)
m m d d y y y y
m m d d y y y y
m m d d y y y y
m m d d y y y y
DISCLAIMER: Membership registration with the Fund does not automatically qualify a Pag-IBIG member to avail of the Fund’s various loan programs.
A Pag-IBIG member must satisfy the eligibility requirements and comply with the documentary requirements, which is subject to
verification and approval.
