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HQP-PFF-226
(V03, 09/2019)
MODIFIED Pag-IBIG II ENROLLMENT FORM
FOR Pag-IBIG FUND USE ONLY
MP2 ACCOUNT NUMBER
5211 8200 4824
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME NO MIDDLE NAME Pag-IBIG MID No.
VILLAROZA RICHARD CAUILAN 1211 0567 7763
PRESENT HOME ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name DATE OF BIRTH
44 DAU February 28, 1990
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code CONTACT DETAILS
MONTE MARIA VILLAGE CATALUNAN GRANDE DAVAO CITY DAVAO DEL SUR , PHILIPPINES 8000 COUNTRY+AREA CODE TELEPHONE NO.
Home
EMPLOYER/BUSINESS NAME (If applicable)
COMMISSION O AUDIT - -
Cell Phone Number
EMPLOYER/BUSINESS ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name
- -
COMMONWEALTH AVENUE
Email Address
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
QUEZON CITY , PHILIPPINES 0880 rvillaroza@[Link]
SOURCE OF FUNDS PREFERRED DIVIDEND PAYOUT
EMPLOYMENT INCOME LOAN MATURITY/SURRENDER OF LIFE POLICY ANNUALLY
SAVINGS/DEPOSITS COMPANY SALE OTHER INCOME SOURCES
FIVE-YEAR (END TERM)
PROPERTY SALE COMPANY PROFITS/DIVIDENDS
SALE OF SHARE OR OTHER INVESTMENT GIFT
FOR LOCALLY-EMPLOYED MEMBERS
AUTHORITY TO DEDUCT (Op�onal)
MODE OF PAYMENT
THIS IS TO AUTHORIZE MY PRESENT AND FUTURE EMPLOYER TO DEDUCT MY MP2 MONTHLY SAVINGS IN THE SALARY DEDUCTION
AMOUNT OF ONE THOUSAND FIVE HUNDRED PESOS (₱1500.00 ) FROM MY SALARY AND REMIT THE SAME TO Pag-IBIG
(For locally-employed members)
FUND.
OVER-THE-COUNTER (OTC)
(at any Pag-IBIG Fund Branch)
THRU ANY ACCREDITED Pag-IBIG COLLECTING
SIGNATURE OVER PRINTED NAME PARTNERS
TERMS AND CONDITIONS
I hereby cer�fy that I fully understand the program and agree to the 8.2 Separa�on from service by reason of health;
following terms and condi�ons: 8.3 Death of the member or any of his/her immediate family member;
8.4 Re�rement;
1. The MP2 program shall be voluntary for the following: 8.5 Permanent departure from the country;
1.1 All Pag-IBIG I members, regardless of their monthly income: and 8.6 Distressed member due to unemployment limited to layoff and/or
1.2 Pensioners, regardless of age, with at least 24 monthly savings closure of company;
prior to re�rement. 8.7 Cri�cal illness of the member or any of his immediate family
2. The enrollment under this program shall be solely a savings scheme. members, as defined under per�nent Guidelines, as cer�fied by a
3. The minimum savings is P500.00 which shall be recorded as of licensed physician under of the following categories, subject to
payment date. However, should I make a one-�me contribu�on that approval:
exceeds P500,000.00, I shall be required to make such payment via - Cancer;
personal or Manager’s Check. - Organ Failure;
4. The MP2 account shall be en�tled to flexible dividend rates higher - Heart-related illness;
than that of Pag-IBIG I which shall be declared a�er the net income - Stroke;
has been computed and approved by the Board of Trustees. - Neuromuscular-related illness.
5. I may opt to have an annual dividend payout or compounded dividend 8.8 Repatria�on of OFW member from host country;
earnings. 8.9 Other meritorious ground as may be approved for by the Board;
6. The membership term shall be five (5) years reckoned from date of 8.10 Circumstances under Items 8.2, 8.4, 8.6 and 8.8 are exclusively
ini�al payment of savings under this program. applicable to Pag-IBIG I members.
7. Upon maturity, should I decide to con�nue my availment of MP2 9. Should I opt to pre-terminate my MP2 membership for reason/s other
program, I understand that I need to apply for a new MP2 account. If I than those allowed, I understand that:
did not withdraw upon maturity, I understand that my MP2 savings 9.1 I shall only be en�tled to 50% of the total dividend earned as
shall cease to earn dividend provided under MP2 program. Instead, penalty for the pre-termina�on of MP2 savings; or
its subsequent dividends shall be based on the rates declared for 9.2 If I opted for the annual dividend payout, I shall only receive my
Pag-IBIG I for the next two (2) years. Therea�er, it shall be contribu�ons.
reclassified as payable account. 10. In case of any change in informa�on, I shall accomplish the
8. Pre-termina�on or withdrawal of MP2 savings prior to maturity shall Member’s Change of Informa�on Form (MCIF) and immediately
be allowed under any of the following circumstances, as applicable: no�fy Pag-IBIG Fund.
8.1 Total disability or insanity;
I further cer�fy under pain of perjury that the informa�on given and any or all statement made herein are true and correct to the best of my knowledge and belief and that
my signature appearing herein is genuine and authen�c.
___________________________________________________________ ________________________________________
SIGNATURE OVER PRINTED NAME DATE
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