Hqp Hlf 068 Form – Fill Out and Use This PDF

PURPOSE OF LOAN

WITH EXISTING HOUSING APPLICATION

 YES

 NO

 Purchase of fully developed residential lot or adjoining residential lots

If yes, indicate Housing Application No. _______________________

 Purchase of a residential house and lot, townhouse or condominium

DESIRED LOAN AMOUNT (Exclusive of

DESIRED LOAN TERM (Years)

unit, inclusive of a parking slot

the co-borrower’s desired loan amount, if any)

 Construction or completion of a residential unit on a residential lot

 Home improvement

DESIRED RE-PRICING PERIOD (Year/s)

 Refinancing of an existing housing loan

 1

 3

 5  10  15

 20  25  30

 Purchase of residential lot plus cost of transfer of title

MODE OF PAYMENT

 Purchase of residential unit plus cost of transfer of title

 Salary deduction

 Collecting Agent

 Purchase of a parking slot

 Over-the-Counter

 Bank

 Post-Dated

Checks

 Developer

 Cash/Check

 Remittance Center

PROPERTY LOCATION (Street, Municipality, Province)

TYPE OF PROPERTY

 Rowhouse

 Single Detached

 Townhouse

 Single Attached

 Condominium

 Duplex

NAME OF DEVELOPER/REGISTERED TITLE HOLDER

DESCRIPTION OF

EXISTING

PROPOSED

IMPROVEMENTS

TCT/OCT/CCT NO.

TAX DECLARATION NO.

LOT/UNIT NO.

BLOCK/BLDG NO.

No. of

STOREYS

IS PROPERTY PRESENTLY

LAND AREA/FLOOR AREA

AGE OF HOUSE (For Purchase of a

TOTAL FLOOR

MORTGAGED?

Residential Unit)

AREA

 YES



NO

SQM

SQM

SQM

IS THE PROPERTY AN OFFSITE COLLATERAL?  YES  NO

REASONS FOR USE OF OFFSITE COLLATERAL

If yes, use separate sheet for the offsite collateral details

BORROWER’S DATA

LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE NAME

CITIZENSHIP

DATE OF BIRTH (mm/dd/yy)

SEX

 M  F

PERMANENT HOME ADDRESS

MARITAL STATUS

Unit/Room No., Floor

Building Name

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

Street Name

 Single/Unmarried

ATTACH HERE

 Married

1”X1”

 Annulled

ID PHOTO

ZIP Code

Subdivision

Barangay

Municipality/City

Province and State Country (if abroad)

 Legally

Separated

OF APPLICANT

 Widow/er

PRESENT HOME ADDRESS

BORROWER’S CONTACT DETAILS (Indicate country code

Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No., House No.

Street Name

if abroad)

COUNTRY + AREA CODE TELEPHONE NO.

Home

Subdivision

Barangay

Municipality/City

Province and State Country (if abroad)

ZIP Code

Cell Phone

HOME OWNERSHIP

YEARS OF STAY IN

EE SSS/GSIS ID No.

Email Address

 Owned

 Company  Living w/ relatives/parents

PRESENT HOME

 Mortgaged  Rented at P__________/mo.

ADDRESS

EMPLOYER/BUSINESS NAME (If self-employed)

TIN

EMPLOYER’S CONTACT DETAILS (Indicate country code

if abroad)

EMPLOYER/BUSINESS ADDRESS

OCCUPATION

COUNTRY + AREA CODE TELEPHONE NO.

Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No., House No.

Street Name

 Employed

Business (Direct Line)

 Self-Employed

Subdivision

Barangay

Municipality/City

Province and State Country (if abroad)

ZIP Code

Business (Trunk Line)

INDUSTRY

Employer/Business Email Address

 Accounting

 Business Process Outsourcing

 Health and Social Work;

 Technology

Activities of Private

(BPO)

Health and Medical Services

 Transport, Storage

Households as

 Construction

 Life Sciences

and Communications

PREFERRED TIME TO BE CONTACTED (For

Employer’s &

 Education & Training

 Management

 Travel and Leisure

Employer)

Undifferentiated

 Electricity, Gas and Water

 Manufacturing

 Wholesale & Retail

Production Activities

Supply

 Media

Trade; Repair of

of Private

 Extra-Territorial Organization &

 Mining and Quarrying

Motor Vehicles,

POSITION & DEPARTMENT

YEARS IN

Households

Bodies

 Other Community, Social &

Motorcycles,

EMPLOYMENT/

Agriculture, Hunting,

 Financial Services/

Personal Service Activities

Personal &

BUSINESS

PREFERRED MAILING ADDRESS

NO. OF

Forestry & Fishing

Intermediation

 Public Administration & Defense;

Household Goods

 Basic Materials

 HR/Recruitment

Compulsory Social Security

 Present Home Address

DEPENDENT/S

 Employer/Business Address

 Permanent Home Address

SPOUSE’S PERSONAL DATA

LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE NAME

Pag-IBIG MID NO./RTN

CITIZENSHIP

DATE OF BIRTH (mm/dd/yy)

TIN

EMPLOYER/BUSINESS NAME (If self-employed)

YEARS IN EMPLOYMENT/ BUSINESS

EMPLOYER/BUSINESS ADDRESS

OCCUPATION

POSITION & DEPARTMENT

Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No., House No.

Street Name

 Employed

 Self-Employed

Subdivision

Barangay

Municipality/City

Province and State Country (if abroad)

ZIP Code

BUSINESS TEL. NO.

INDUSTRY

 Accounting

 Business Process Outsourcing (BPO)

 Life Sciences

 Technology

 Activities of Private Households as

 Education & Training

 Management

 Transport, Storage and

Employer’s & Undifferentiated Production

 Electricity, Gas and Water Supply

 Manufacturing

Communications

Activities of Private Households

 Extra-Territorial Organization & Bodies

 Media

 Travel and Leisure

 Agriculture, Hunting, Forestry & Fishing

 Financial Services/ Intermediation

 Mining and Quarrying

 Wholesale & Retail Trade;

 Basic Materials

 HR/Recruitment

 Other Community, Social & Personal Service Activities

Repair of Motor Vehicles,

 Construction

 Health and Social Work;

 Public Administration & Defense; Compulsory Social

Motorcycles, Personal &

Health and Medical Services

Security

Household Goods

HQP-HLF-068

(V08, 02/2020)

BANK ACCOUNTS (Indicate your 3 most active)

BANK

BRANCH/ADDRESS

TYPE OF ACCOUNT

ACCOUNT NO.

DATE OPENED

AVE. BALANCE

CREDIT CARDS OWNED (Indicate your 3 most active)

ISSUER NAME

CARD TYPE

CARD EXPIRY

CREDIT LIMIT

(e.g. Visa/Mastercard)

(mm/yyyy)

REAL ESTATE OWNED

LOCATION

TYPE OF PROPERTY

ACQUISITION COST

MARKET VALUE

MORTGAGE

RENTAL INCOME

BALANCE

OUTSTANDING CREDITS/LOAN AVAILMENTS

Creditor & Address

Security

Type

Maturity Date

Amount/Balance

Mo. Amortization

Creditor & Address

Security

Type

Maturity Date

Amount/Balance

Mo. Amortization

Creditor & Address

Security

Type

Maturity Date

Amount/Balance

Mo. Amortization

MISCELLANEOUS

(Answer the following questions with YES or NO. If your answer is YES, please elaborate the details as required)

Are there past or pending cases against you?  Yes

 No

If Yes, please indicate the nature, plaintiff, amount involved and the status.

Do you have past due obligations?

 Yes  No

If yes, please indicate the creditor’s name, nature, amount involved and due date.

Was your bank account ever closed because of mishandling or issuance of bouncing checks?  Yes

 No

If yes, please indicate the bank’s name, nature amount and date.

Have you ever been diagnosed, treated or given medical advice by a physician or other health care provider?  Yes  No

If yes, please indicate the condition/diagnosis.

LOAN AND CREDIT REFERENCES

BANK/FINANCIAL INSTITUTION

ADDRESS

PURPOSE

SECURITY

HIGHEST

PRESENT

DATE

DATE FULLY

AMOUNT OWED

BALANCE

OBTAINED

PAID

TRADE REFERENCES (For Self-Employed Only)

NAME OF SUPPLIER

ADDRESS

TEL. NO.

CHARACTER REFERENCES

NAME

ADDRESS

TEL. NO.

SELLER’S DATA

LAST NAME

FIRST NAME

NAME EXTENSION

MIDDLE NAME

Pag-IBIG MID NO./RTN

TIN

Unit/Room No., Floor Building Name

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

Street Name

CONTACT NUMBER

Subdivision

Barangay

Municipality/City

Province and State Country (if abroad)

ZIP Code

EMAIL ADDRESS

SOURCE OF Pag-IBIG FUND HOUSING LOAN INFORMATION

 TV Ad

 Radio Ad

 Pag-IBIG Fund

 Flyer/Poster/Brochure

 Employer

 Newspaper/Magazine Ad

Personnel

 Website

 Agency

 Pag-IBIG Fund

 Real Estate Developer

 Seller of the Property

 Others (pls. specify) ______________

Branch

_____________________________________________

_________________________________________

SIGNATURE OVER PRINTED NAME OF BORROWER

SIGNATURE OVER PRINTED NAME OF SPOUSE

____________________________________

____________________________________

DATE

DATE