SLF065 MultiPurposeLoanApplicationForm V08
SLF065 MultiPurposeLoanApplicationForm V08
(V08, 10/2024)
MULTI-PURPOSE LOAN APPLICATION FORM (MPLAF)
INSTRUCTIONS:
1. Accomplish this form in one (1) copy only. Print this form back to back on one single sheet of paper. Pag-IBIG MID NO. APPLICATION NO.
2. Type or print all entries in BLOCK or CAPITAL LETTERS.
3. All data fields are mandatory. Otherwise, put N/A if not applicable.
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME MAIDEN MIDDLE NAME NO MIDDLE NAME DATE OF BIRTH PLACE OF BIRTH
(e.g., Jr., II) (for married women) (check if applicable only)
COMPLETE MOTHER’S MAIDEN NAME NATIONALITY SEX MARITAL STATUS CITIZENSHIP EMAIL ADDRESS
Male Single/Unmarried Widow/er Annulled
Female Married Legally Separated
PRESENT HOME ADDRESS Unit/ Room No., Floor Building Name Lot No., Block No., Phase No. House No. CELL PHONE NUMBER HOME TELEPHONE NUMBER
Street Name Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code APPLICANT’S TAXPAYER SSS/GSIS NO.
IDENTIFICATION NUMBER (TIN)
PERMANENT HOME ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. BUSINESS TELEPHONE NATURE OF WORK
NUMBER
Street Name Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code LOAN TERM DESIRED LOAN AMOUNT
Two (2) Years Maximum Loan Amount
Three (3) Years Others, specify:
EMPLOYER/BUSINESS NAME LOAN PURPOSE
Non-Housing Related
Vacation/travel
EMPLOYER/BUSINESS ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name Livelihood/additional capital in
Special events
small business
Car repair
Tuition/Educational Expenses
Health & wellness
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code Payment of utility/credit card bills
Purchase of appliance &
furniture/electronic gadgets
Others, specify
EMPLOYEE ID NUMBER DATE OF EMPLOYMENT SOURCE OF FUND Housing Related
Minor home improvement/home
renovation/ upgrades
PREVIOUS EMPLOYMENT DETAILS FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME EMPLOYER/BUSINESS ADDRESS FROM (mm/yy) TO (mm/yy)
APPLICATION AGREEMENT
In consideration of the loan that may be granted by virtue of this application subject to the pertinent provisions of the Implementing This office agrees to collect the corresponding monthly
Rules and Regulations of Pag-IBIG Fund, I hereby waive my rights under R.A. No. 1405 (Secrecy of Bank Deposits Act) and amortization on this loan and the MS of herein applicant
authorize Pag-IBIG Fund to verify/validate my payroll account/disbursement card. Furthermore, I hereby authorize my present through salary deduction, together with the employer
employer, counterpart, and remit said amounts to Pag-IBIG Fund on or
or any employer with whom I may get employed before the 15th day of each month, for the duration that the
in the future, to deduct the membership savings (MS) and monthly amortization due from my salary and remit the same to Pag-IBIG loan remains outstanding. However, should we deduct the
Fund. If the resulting monthly net take home pay after deducting the computed monthly amortization on MPL falls below the monthly monthly amortization due from the applicant’s salary but
net take home pay as required under the GAA/company policy, I authorize Pag-IBIG Fund to compute for a lower loanable amount. failed to remit it on due date, this office agrees to pay the
I understand that should I fail to pay the monthly amortization due, I shall be charged with a penalty of 1/20 of 1% of any unpaid corresponding penalty charged to applicant equivalent to 1/20
amount for every day of delay. of 1% of any unpaid amount for every day of delay and
If for any reason excess loan proceeds are erroneously credited to my payroll account/disbursement card, I hereby authorize Pag-IBIG penalty for non- remittance equivalent to 1/10 of 1% per day
Fund to debit/deduct the excess amount from my account without need of further notice of demand. Should my account balance be of delay of the amount payable from the date the loan
insufficient, the Fund has the right to demand for the excess amount to be refunded. amortization or payments fall due until paid.
I authorize Pag-IBIG Fund to disclose, submit, share or exchange any of my account information to legal and government regulating
agencies, other banks, partner-merchants or third party in accordance with R.A. No. 9510 (Credit Information System Act), R.A. No.
10173 (Data Privacy Act of 2012), and other related or pertinent laws and regulations, as described in Pag-IBIG Fund’s Freedom of
Information (FOI) Manual. The credit information may also be transferred to service providers (e.g., Credit Information Corporation, AUTHORIZED SIGNATORY
Bankers Association of the Philippines - Credit Bureau), likewise in accordance with laws and regulations. (Signature Over Printed Name)
Furthermore, I have read, understood and agree to be bound by the terms and conditions governing the
eDisbursement Facility/Program and Pag-IBIG Fund’s partner-banks’ internal guidelines.
DESIGNATION
I certify that the information given and any or all statements made herein are true and correct to the best of my knowledge and belief. I
hereby certify under pain of perjury that my signature appearing herein is genuine and authentic.