HQP-PFF-039

(V10, 04/2023)
FOR Pag-IBIG Fund USE ONLY

MEMBER’S DATA FORM Pag-IBIG MID NO.

(MDF) REGISTRATION TRACKING NO.

INSTRUCTIONS
1. Accomplish this form in one (1) copy only. If registration is thru online, the form 6. The “NAME EXTENSION” shall refer to JR., II, III and the like.
should be printed back to back on a single sheet of paper. 7. Indicate the full name of your FATHER and MOTHER as they appear in your birth certificate.
2. Submit photocopy of at least one (1) valid ID acceptable to the Fund. 8. On the “OCCUPATION” portion, indicate your job, profession, or type of work to earn a living.
3. Type or print all entries in BLOCK or CAPITAL LETTERS. 9. On the “HEIRS” portion, the provision on the Laws on Succession, under the New Civil Code, shall
4. All fields marked with asterisk (*) are mandatory. be observed.
5. On the “OCCUPATIONAL STATUS” portion, if not employed or purpose is pre- 10. For any subsequent change of information, please secure and accomplish Member’s Change of
employment, select “UNEMPLOYED/NOT YET EMPLOYED”. For first time Information Form (MCIF, HQP-PFF-049) and submit to any Pag-IBIG Branch nearest you.
jobseekers, select also the “CHECK THIS BOX IF FIRST TIME JOBSEEKERS”.

*OCCUPATIONAL STATUS  EMPLOYED  UNEMPLOYED/NOT YET EMPLOYED

 CHECK THIS BOX IF FIRST TIME JOBSEEKERS
*MEMBERSHIP CATEGORY
MANDATORY VOLUNTARY
 EMPLOYED  SELF-EMPLOYED  EMPLOYED  INDIVIDUAL PAYOR
 PRIVATE  PROFESSIONAL/BUSINESS OWNER  EMPLOYEE OF FOREIGN  MEMBER OF COOPERATIVE
 GOVERNMENT  JOB ORDER PERSONNEL GOVERNMENT  MEMBER OF TRADE UNION
 PRIVATE HOUSEHOLD  OTHER EARNING GROUP (OEGs)  BARANGAY OFFICIAL/EMPLOYEE  NON-WORKING SPOUSE
 OVERSEAS FILIPINO Please specify:  OTHERS, Please specify  MEMBER OF RELIGIOUS GROUP
WORKER (OFW)  OTHERS, Please specify  OVERSEAS FILIPINO IMMIGRANT
 PENSIONER/INVESTOR/LESSOR

PERSONAL DETAILS
FIRST NAME NAME EXTENSION MIDDLE NAME NO MIDDLE NAME
NAME LAST NAME (e.g. Jr., II) (check if applicable only)

*MEMBER 

FATHER 

*MOTHER (Maiden Name) 

*SPOUSE (If Married) 

MEMBER’S NAME AS APPEARING IN THE
BIRTH CERTIFICATE 
*DATE OF BIRTH *MARITAL STATUS TAXPAYER IDENTIFICATION NUMBER (TIN)
 Single/Unmarried  Widow/er  Annulled
m m d d y y y y  Married  Legally Separated
*PLACE OF BIRTH (City/Municipality/Province/Country) *CITIZENSHIP SSS/GSIS NUMBER
(Please indicate country if born outside the Philippines)

EMPLOYEE NUMBER
*SEX HEIGHT WEIGHT PROMINENT DISTINGUISHING FACIAL FEATURES
 Male (Ex. Moles, Scars, etc.)
 Female (cm) (kg) For AFP/PNP Employee, Serial/Badge No.
COMMON REFERENCE NUMBER (CRN) FREQUENCY OF MEMBERSHIP SAVINGS (MS)
(If Available) PAYMENT (If payment of MS is not thru payroll deduction) For DepEd Employee, Division Code-Station Code
 Monthly  Quarterly

ADDRESS AND CONTACT DETAILS

*PERMANENT HOME ADDRESS (Indicate country code if abroad)
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name COUNTRY + AREA CODE TELEPHONE NUMBER
Home
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
*Cell Phone

*PRESENT HOME ADDRESS

Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name Business (Direct Line)

Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code Business (Trunk Line) Local

*PREFERRED MAILING ADDRESS Email Address

 Present Home Address  Permanent Home Address  Employer/Business Address

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

 HQP-PFF-039
(V10, 04/2023)

PRESENT EMPLOYMENT DETAILS (If with more than one (1) employer, use separate sheet and follow format below)
*OCCUPATION EMPLOYMENT STATUS TYPE OF WORK (For OFW only)
 Permanent/Regular  Contractual  Part-time/ (Pls. specify country of assignment)
 Casual  Project-based Temporary  Land-based
 Sea-based
*EMPLOYER/BUSINESS NAME MONTHLY INCOME
Basic
+
*EMPLOYER/BUSINESS ADDRESS Allowances/Others
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. =
Total Mo. Income
Street Name Subdivision Barangay OFFICE ASSIGNMENT
 Head Office  Branch
Municipality/City Province State/Country (If abroad) ZIP Code DATE EMPLOYED (Month, Year)

PREVIOUS EMPLOYMENT FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
 Head Office  Branch
EMPLOYER/BUSINESS ADDRESS FROM TO

m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
 Head Office  Branch
EMPLOYER/BUSINESS ADDRESS FROM TO

m m y y y y m m y y y y
EMPLOYER/BUSINESS NAME OFFICE ASSIGNMENT
 Head Office  Branch
EMPLOYER/BUSINESS ADDRESS FROM TO

m m y y y y m m y y y y

HEIRS (In case of death, Fund benefits shall be divided among the member’s heirs in accordance with the Rules of Succession under the New Civil Code, as amended) (Use another sheet if necessary)
NAME NO MIDDLE NAME
LAST NAME FIRST NAME MIDDLE NAME RELATIONSHIP DATE OF BIRTH
EXTENSION (Check only if applicable)


m m d d y y y y

 m m d d y y y y


m m d d y y y y


m m d d y y y y

CERTIFICATION
I hereby certify that the information given, and all statements made herein are true and correct. Likewise, I hereby authorize Pag-IBIG Fund to collect record, organize,
update/modify, consult, use, consolidate, block, erase or destruct my personal data as part of my information. I hereby affirm my right to: (a) be informed; (b) object to
processing; (c) access; (d) rectify, suspend or withdraw my personal data; (e) damages; and (f) data portability pursuant to the provision of R.A. No. 10173 (Data Privacy Act
of 2012).

SIGNATURE OF INFORMANT DATE

FOR Pag-IBIG FUND USE ONLY

RECEIVED BY DATE

Signature over Printed Name Designation/Position Branch/Unit

DISCLAIMER
Membership registration with the Fund does not automatically qualify a Pag-IBIG member to avail of the Fund’s various programs. A Pag-IBIG
member must satisfy the eligibility requirements and comply with the documentary requirements, which is subject to verification and approval.
 ANNEX A

GUIDE IN ACCOMPLISHING MEMBER’S DATA FORM (MDF)

FRONT BACK

1 Pag-IBIG MID No. - a unique 12-digit number series  Mandatory Coverage

assigned to a registered member. To be accomplished by
Pag-IBIG Fund. a. Employed
2 Registration Tracking No. (RTN) - refers to system- Private - any person in service of a private
generated number issued after completion of online employer and who receives compensation for such
registration. services rendered, may or may not be registered
yet with the Social Security System (SSS); will also
3 Instructions - refers to quick guide in accomplishing the include the following:
MDF. - Employees of foreign-based employers with an
administrative agreement with the Fund
4 Occupational Status - check the appropriate box to
indicate working status of a person either employed, Government - any person in service of any of the
unemployed or not yet employed (for first time jobseeker). government offices that are coverable by the GSIS;
will also include the following:
5 Membership Category - check the appropriate box to - Uniformed personnel of the Armed Forces of the
indicate type of membership coverage as defined under Philippines, Philippine National Police, Bureau of
R.A. 9679. Fire Protection, Bureau of Jail Management and
Penology
- Members of the Judiciary and Constitutional
Commissions
 Private Household – any individual rendering  Voluntary Coverage
domestic services exclusively to a household; may
include the following: a. Employed
- Housemaid/Housekeeper
- Nanny Employee of Foreign Government - refers to
- Gardener employee of foreign government
- Cook (embassies/consulates) or international
- Driver organizations without an administrative agreement
- Butler with the Fund.
- Guard
- Governess Barangay Official/Employee - refers to any
- Launderer person in authority in their jurisdictions, or who may
be designated by law or ordinance and charged
b. Overseas Filipino Worker (OFW) - any person with the maintenance of public order, protection
working for a foreign-based employer, whether and security of life and property, or the
deployed or for deployment abroad, or a maintenance of a desirable and balanced
combination of local and overseas deployment, environment, or who comes to the aid of persons in
whether based on land or at sea. authority.

c. Self-employed (SE) - any person not over sixty b. Individual Payor

(60) years old, who is practicing his/her profession,
or engaged in any trade, business or occupation, Member of Cooperative - a member of an
with monthly average income/ earnings of at least autonomous and duly registered association of
P1,000 and is not under an employer-employee persons, with a common bond of interest, who have
relationship. voluntarily joined together to achieve their social,
economic, and cultural needs and aspirations by
Professional/Business Owner - refers to making equitable contributions to the capital
individual that earns income through conducting required, patronizing their products and services
profitable operations from a trade or business that and accepting a fair share of the risks and benefits
he operates directly. of the undertaking in accordance with the
universally accepted cooperative principles; or
Job Order Personnel - refers to hired workers for
a piece of work or intermittent job of short duration
Member of Trade Union - a member of an
not exceeding six (6) months and is paid on a daily
organization whose membership consists of
or hourly basis and has no employee-employer
workers and union leaders, united to protect and
relationship.
promote their common interest.
Other Earning Group (OEGs) - this refers to small
scale units engaged in the production of goods and Non-Working Spouse - refers to a spouse who
services with the primary objective of generating devotes full time to managing the household and
employment and income to the person concerned family affairs.
in order to earn a living.
Member of Religious Group - refers to individual,
head or leader of any organization in the exercise of
- Public Utility Transport Driver
religious belief.
- Market Vendor
- Farmer
Overseas Filipino Immigrant - refers to a person
- Fisher Folk
of Filipino origin who lives out of the Philippines as
- Others (Other similar self-employed individuals)
citizen or as permanent resident of a different
country.

Pensioner - any person receiving old-age or

permanent total disability pension or any person
who has received the lump sum excluding one
receiving survivorship pension benefits; or

Investor - the owner of investor securities or

investor share where investor securities or shares
mean shares of stock issued by a Real Estate
Investment Trust (REIT) or derivatives thereof; or

Lessor - shall include the owner or administrator or

agent of the owner of the residential unit.
 22
6 Member’s Name - this portion shall be accomplished in SSS/GSIS Number - for private employees, indicate your
the following order: 10-digit Social Security Number, and for government
 Last Name - refers to the family name or surname.
employees, indicate your 11-digit Business Partner Number.
 First Name - refers to the given name.
 Name Extension - refers to Jr., II, III and the like. Employee Number - refers to your company ID number.
23
 Middle Name - refers to registrant’s mother’s maiden last  For AFP/PNP Employee, indicate Serial/Badge No.
name or for married women, refers to father’s last name.  For DepEd Employee, aside from Employee Number,
 No Middle Name - this portion shall be checked if indicate Division Code-Station Code
informant is not using a middle name, such as the
Chinese. 24 Permanent Home Address - indicate the address of your
permanent residence.
7 Father’s Name Please refer to item
no. 6 in accomplishing 25 Present Home Address - indicate the address where you
8 Mother’s Name (Maiden Last Name, First currently reside, and the state/country only if present address
Name, Name is outside the Philippines.
Name) Spouse’ Name Extension, and Middle
9
Name
26 Preferred Mailing Address - check the appropriate box
Member’s Name as Appearing in the Birth Certificate to indicate your chosen address to receive mail.
10
- indicate Member’s name based on Birth Certificate.
27 Contact Numbers - indicate the country and area code only
11 Date of Birth - indicate date of birth in the following
if outside Metro Manila or based abroad.
format: mm/dd/yyyy
Example: If born on January 14, 1980, please write 01
28 Occupation - indicate your job, profession, or type of work to
14 1980.
earn a living.

12 Place of Birth - indicate the City/Municipality/ For Other Working Group (OWG)/Informal Sector, select from
Province/Country where the registrant was born. Specify the following:
only the country if born outside the Philippines.
- Public Utility Transport Driver
13 Sex - check the appropriate box. - Market Vendor
- Farmer
14 Height - indicate height in centimeters (cm). Conversion: 1 - Fisher Folk
foot = 30.48 cm - Others (Other workers in the informal sector)
1 inch = 2.54 cm
Example: 5’3” = 160.02 cm 29 Employment Status - check the appropriate box.

15 Weight - indicate weight in kilograms (kg). 30 Employer/Business Name - indicate complete

Conversion: 1 pound (lb) = 0.4536 kilogram Employer/Business Name appearing in the registration
Example: 120 lbs = 54.43 kg certificate or employment contract (applicable for Formally
16 Common Reference Number (CRN) - indicate if Employed, OFW and Self-employed Professional/Business
available. Owner).

17 Marital Status - check the appropriate box. 31 Employer/Business Address - indicate complete
Employer/Business Address appearing in the registration
certificate or employment contract (applicable for Formally
18 Citizenship - indicate your nationality.
Employed, OFW and Self- employed Professional/Business
Owner).
19 Prominent Distinguishing Facial Features - indicate
your distinguishing features that can be found on the face
32 Type of Work - check the appropriate box (applicable for
such as “mole under the right eye” or “mole or birth mark on
OFW only).
the left cheek/forehead”.
33 Monthly Income - indicate your income or earning per
20 Frequency of Membership Savings (MS) Payment -
month.
check appropriate box if payment of MS is not thru payroll
deduction.
34 Office Assignment - check the appropriate box to indicate
whether assigned to Head Office or a particular Branch.
21 Taxpayer Identification Number (TIN) - indicate your
9-digit TIN issued by the Bureau of Internal Revenue (BIR).
35 Date Employed - indicate inclusive date of employment under
current employer.

36 Previous Employment From Date of Pag-IBIG

Membership - indicate details of your previous
employment.

37 Heirs - indicate your legal heir/s in accordance with the

Laws of Succession, as provided in the New Civil Code of
the Philippines, as amended.

38 Certification - affix your signature and indicate the date when

the MDF was accomplished.
39 Acknowledgement - to be accomplished by Pag-IBIG Fund.