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HQP-HLF-169 Application for Housing Loan Revaluation

Pag - Ibig housing loan application form for loan revaluation under non - performing assets resolution program

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APPLICATION NO.

HOUSING LOAN APPLICATION
FOR REVALUATION

DATE FILED

TIME

(PLEASE PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS)

LOAN REVALUATION PARTICULARS
DESIRED RE-PRICING PERIOD

HL ACCOUNT NO.

3

DESIRED LOAN TERM (Years)

5

10

MODE OF PAYMENT
Salary deduction
Remittance Center

15

Post Dated Checks
Bank

Collecting Agent

PRINCIPAL BORROWER’S DATA
LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE NAME

(e.g. Jr., II)

DATE OF BIRTH (mm/dd/yy)

SEX

CITIZENSHIP

MALE
FEMALE

Pag-IBIG MID/RTN NO.

MAIDEN NAME
(for married women only)

Attach Here
1” x 1”
ID PHOTO

MARITAL STATUS
Single/Unmarried
Married

Legally Separated
Annulled/Divorced

Widow/er
CONTACT DETAILS
(Indicate country code if abroad)

PERMANENT HOME ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Blk No., Phase No., House No.

Subdivision

Barangay

Municipality/City

Street Name

COUNTRY + AREA CODE TELEPHONE NO.
Province and State Country (if abroad)

HOME TEL. NO.

Zip Code

BUSINESS TEL NO.
PRESENT HOME ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Blk No., Phase No., House No.

Subdivision

Barangay

Municipality/City

Street Name

CELLPHONE NO.
Province and State Country (if abroad)

Zip Code

E-MAIL ADDRESS
OCCUPATION
Locally Employed

GROSS MONTHLY INCOME
Self-Employed

Overseas Filipino Worker (OFW)

P

TAXPAYERS IDENTIFICATION NO. (TIN)

EMPLOYER/BUSINESS NAME
SSS/GSIS ID NUMBER
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Blk No., Phase No., House No.

Subdivision

Barangay

Municipality/City

Street Name

Province and State Country (if abroad)

PREFERRED MAILING ADDRESS
Permanent Home Address
Present Address
Employer/Business Address

Zip Code

LEGAL HEIR’S DATA
LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE NAME

(e.g. Jr., II)

DATE OF BIRTH (mm/dd/yy)

SEX

CITIZENSHIP

RELATION TO PRINCIPAL BORROWER
Spouse
Son/Daughter
Brother/Sister

MALE
FEMALE

Pag-IBIG MID/RTN NO.

MAIDEN NAME
(for married women only)

Parent
Other (please specify)
_________________

MARITAL STATUS
Single/Unmarried
Married
Widow/er

Building Name

Lot No., Blk No., Phase No., House No.

Legally Separated
Annulled/Divorced

CONTACT DETAILS
(Indicate country code if abroad)

PERMANENT HOME ADDRESS
Unit/Room No., Floor

Attach Here
1” x 1”
ID PHOTO

Street Name

COUNTRY + AREA CODE TELEPHONE NO.
Subdivision

Barangay

Municipality/City

Province and State Country (if abroad)

Zip Code

HOME TEL. NO.

BUSINESS TEL NO.
PRESENT HOME ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Blk No., Phase No., House No.

Subdivision

Barangay

Municipality/City

Street Name

CELLPHONE NO.
Province and State Country (if abroad)

Zip Code

E-MAIL ADDRESS
OCCUPATION
Locally Employed

GROSS MONTHLY INCOME
Self-Employed

Overseas Filipino Worker (OFW)

P

TAXPAYERS IDENTIFICATION NO. (TIN)

EMPLOYER/BUSINESS NAME
SSS/GSIS ID NUMBER
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor

Building Name

Lot No., Blk No., Phase No., House No.

Subdivision

Barangay

Municipality/City

Street Name

Province and State Country (if abroad)

Zip Code

PREFERRED MAILING ADDRESS
Permanent Home Address
Present Address
Employer/Business Address

CERTIFICATION
I certify that the foregoing information/statement is to my knowledge, true, correct, complete, and updated. The signature appearing below is genuine. I authorize Pag-IBIG
Fund to conduct verification on all the details stated on this document as well as the other documents I have submitted from whatever source that it may consider appropriate to
establish its correctness, validity, and authenticity.
I hereby agree that any misrepresentation of a material fact is a ground for disapproval of the application, cancellation of the loan, and shall be a cause for the total
outstanding obligation to be due and demandable and shall be subject to other sanctions provided in existing Pag-IBIG guidelines. I agree to notify Pag-IBIG Fund of any material
change affecting the information contained herein. I agree that all information obtained by Pag-IBIG Fund shall remain its property whether or not the loan is granted.

___________________________________

____________

PRINCIPAL BORROWER/LEGAL HEIR’S
SIGNATURE OVER PRINTED NAME

DATE

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

(September 2012)
 
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