MEMBER’S DATA FORM
1 x 1 Colored
FOR Pag-IBIG OVERSEAS PROGRAM
ID Picture
Please accomplish this form in two (2) copies
POP Membership ID Number
MIDDLE NAME
SEX
CIVIL STATUS
MAILING ADDRESS (PHILIPPINES)
HOME TEL. NO.
CELLPHONE NO.
MAILING ADDRESS (ABROAD, NUMBER, STREET, CITY, STATE, ZIP CODE)
HOME TEL. NO.
CELLPHONE NO.
Atrium of Makati, Makati Avenue, Makati City
Tel. Nos. 811-4401 to 29 (Connecting all departments)
FAMILY NAME
FIRST NAME
PLACE OF BIRTH
MAIDEN NAME (IF MARRIED)
TIN
DATE OF BIRTH (MM / DD / YY)
PASSPORT NO.
COMPANY EMPLOYER NAME
RECRUITMENT MANAGING AGENCY
COMPANY EMPLOYER ADDRESS
OFFICE TEL. NO.
FAX / TELEFAX NO.
MEMBERSHIP IN FILIPINO ORGANIZATIONS (USE ANOTHER SHEET IF NECESSARY)
NAME OF ORGANIZATION
GROSS MONTHLY
INCOME ($)
ADDRESS & MEMBERSHIP CATEGORY
DESIRED MEMBERSHIP
MATURITY
TELEPHONE NO.
I HEREBY CERTIFY THAT THE ABOVE DATA AND
INFORMATIONS ARE TRUE AND CORRECT
SPECIMEN SIGNATURE (for POP ID):
FIVE (5) YEARS
TEN (10) YEARS
________________________________
SIGNATURE OF APPLICANT
____________
DATE
__________________________
RECRUITED BY
FOR HDMF USE ONLY
CONTRIBUTION RATE
RECEIVED BY / DATE
PFR NO.
PFR DATE
AMOUNT
PERIOD COVERED
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DETACHED THIS PORTION FOR YOUR PREFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remittance of contributions may be made through our accredited collecting banks:
Europe
PNB London (Savings Acct. No. 0725-219601-401)
ABC UK (UKD 2000097)
Middle East
BPI – Atrium (Savings Acct. No. 3124-0221-09) Speedcash
ABC Head Office (Savings Acct.
Asia Pacific
PNB HK (Savings Acct. No. 0730-475270-501)
Canada
Bank of Nova Scotia (Savings Acct. No. 2164-10
United States of America
Oceanic Bank (Savings Acct. No. 3700143)
PNB New York (Savings Acct. No. 1713)
ABC Guam (Savings Acct. No. 5000-00355-4)
Remittance may also be made to any of the following banks:
RCBC (Savings Acct. No. 8000-08787-5)
PNB Makati Ave. (Savings Acct. No. 265706641-1)
LBP (Savings Acct. No. 2204-008496)
PCIB (Savings Acct. No. 5463-00176-8
VERIFIED BY/DATE
Please fax to (632) 848-8207 your bank deposit slip or email to info@pagibigoverseas.com for immediate
posting/reconciliation of your payments. Contributions may also be remitted through the Pag-IBIG Head Office, Branch and
Regional Offices in the Philippines where remittance by a close relative is deemed most convenient.
For Further Inquiries, Visit or Call:
Pag-IBIG OVERSEAS PROGRAM DEPARTMENT
Room 608 Atrium Bldg., Makati Avenue, Makati City 1200 Philippines
Telephone Nos. (632) 811-4054 / 811-4272 / 811-4273 or Fax Nos. (632) 848-8207 / 811-4146
E-mail Addresses: info@pagibigoverseas.com
Website: www.pagibioverseas.com
THIS FORM MAY BE REPRODUCED. NOT FOR SALE