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HQP-SLF-017 STL Remittance Form
Pag-Ibig remittance form for STL
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SHORT-TERM LOAN
REMITTANCE FORM (STLRF)
Pag-IBIG EMPLOYER’S ID NUMBER
NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.
EMPLOYER/BUSINESS NAME
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor
Building Name
Subdivision
Barangay
PERIOD COVERED
Lot No., Block No., Phase No. House No.
Municipality/City
Province/State/Country (if abroad)
Street Name
ZIP Code
TELEPHONE NUMBER
NAME OF MEMBERS
Pag-IBIG
MID NO.
APPLICATION NO.
Last Name
First Name
Name Extension
(Jr., III, etc.)
Middle Name
LOAN TYPE
(e.g., MPL, Calamity Loan)
EMPLOYER
REMARKS
AMOUNT
TOTAL FOR THIS PAGE
GRAND TOTAL (if last page)
EMPLOYER CERTIFICATION
I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best of my knowledge and belief. I
further certify that my signature appearing herein is genuine and authentic.
___________________________________________________
HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE
(Signature Over Printed Name)
__________________________________
DESIGNATION/POSITION
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
_________________________
DATE
(V02, 10/2016)
GUIDELINES AND INSTRUCTIONS
a. Type or print all entries in BLOCK or CAPITAL LETTERS.
f.
b. Accomplish this form in softcopy when making remittances to Pag-IBIG Fund
or to any accredited collecting partner on or before the fifteenth (15th) day of
the month.
c. A separate Short-Term Loan Remittance Form (STLRF) should be
accomplished per type of payment (whether cash or check payment) and in
case Credit Memo shall be applied as payment to the Fund.
d. In case there is a correction in the remittance which resulted to overpayment,
the employer shall advise the Fund. Once validated, a Notice of
Overpayment and Credit Memo shall be issued to the employer. From the
date of issuance of the said Notice, the employer may request, not later than
six (6) months for refund of the excess amount or have it applied to the future
remittance with the Fund.
e. The total amount to be remitted should be equal to the total amount reflected
on the STLRF. Check payments should be made payable to Pag-IBIG Fund
and shall be posted upon clearing (clearing policy shall not be applicable to
National Government Agency (NGA), instead payment shall be posted within
72 hours upon receipt of collection).
Failure or refusal of the Employer to pay or to remit the
contributions herein prescribed shall not prejudice the right of the
covered employee to the benefits under the Fund. Such Employer
shall be charged a penalty equivalent to 1/10 of 1% per day of
delay of the amount due starting on the first day immediately
following the due date until the date of full settlement.
1
Pag-IBIG Employer’s ID No. – assigned Pag-IBIG Employer’s ID
Number.
2
Employer/Business Name – per DTI/SEC Registration.
3
Employer/Business Address - indicate Unit/Room No., Floor,
Building Name or Lot No., Block No., Phase No. or House No. and
Street Name, Subdivision, Barangay, Municipality/City, Province,
and ZIP Code.
4
Period Covered – indicate the applicable month and year of MS
remittance in the following format: yyyy/mm.
5
Telephone Number – indicate current telephone number.
6
Pag-IBIG MID No. – indicate the borrower’s assigned Pag-IBIG
Membership Identification (MID) Number.
7
Application No. – indicate the borrower’s loan application number
per type of loan.
1
8
2
4
3
9
5
6
7
Name of Borrower – indicate borrower’s complete name in the
following format: Last Name, First Name, Name Extension (Jr., III,
etc.), Middle Name
8
9
10
10
11
11
Loan Type – indicate if payment is intended for Multi-Purpose
Loan (MPL) or Calamity Loan (CL) in the following format: MPL or
CL
Amount – indicate the amount due as indicated in the latest billing
statement
Employer Remarks – accomplish this portion only to report
changes in the borrower’s employment status and to update any
information regarding the borrower. Indicate the appropriate code
and effectivity date in the following formate (mm/dd/yy) on the
space provided. Please refer to the following codes and examples.
N
- Newly Hired
Examples
L
- Leave Without Pay/AWOL
1. N: 1/4/2013
RS
- Resigned/Separated
2. L:
RT
- Retired
3. RS: 1/3/2013
D
- Deceased
4. D: 1/14/2013
O
- Others, please specify reason
1/21/2013
12
13
14
Indicate the grand total of the total amount due if this is the last
page.
14
12
13
Indicate the total amount due per page.
Employer Certification - to be accomplished and duly signed by
the Head of Office/Authorized Representative.
