HQP-SLF-065

(V10, 05/2025)
MULTI-PURPOSE LOAN APPLICATION FORM (MPLAF)
INSTRUCTIONS:
1. Accomplish this form in one (1) copy only. Print this form back to back on a single sheet of paper. Pag-IBIG MID NO. APPLICATION NO.
2. Type or print all entries in BLOCK or CAPITAL LETTERS.
3. All data fields are mandatory. Otherwise, put N/A if not applicable. 1210 9018 3046
LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME MAIDEN MIDDLE NAME NO MIDDLE NAME DATE OF BIRTH PLACE OF BIRTH
(e.g., Jr., II) (for married women) (check if applicable only)
DICHOSO REGINA ANDRES LARANANG  11 - 24 - 1992 MALABON CITY
COMPLETE MOTHER’S MAIDEN NAME NATIONALITY SEX MARITAL STATUS CITIZENSHIP EMAIL ADDRESS
 Male  Single/Unmarried  Widow/er  Annulled
EMMA NINO LARANANG FILIPINO /  Female  /
Married  Legally Separated FILIPINO [email protected]
PERMANENT HOME ADDRESS Unit/ Room No., Floor Building Name Lot No., Block No., Phase No. House No. CELL PHONE NUMBER HOME TELEPHONE NUMBER

L47 B6 0965 500 1672

Street Name Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code APPLICANT’S TAXPAYER SSS/GSIS NO.
IDENTIFICATION NUMBER (TIN)
CALIENTE VALLE ALEGRE BUBUYAN CALAMBA LAGUNA 4027 908 758 461 200 5965 423
PRESENT HOME ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. BUSINESS TELEPHONE NUMBER NATURE OF WORK

L47 B6 ADMIN
Street Name Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code LOAN TERM DESIRED LOAN AMOUNT
 One (1) Year / /
 Three (3) Years  Maximum Loan Amount
CALIENTE VALLE ALEGRE BUBUYAN CALAMBA LAGUNA 4027  Two (2) Years  Others, specify: ______________
EMPLOYER/BUSINESS NAME LOAN PURPOSE
DEPARTMENT OF EDUCATION Non-Housing Related
 Livelihood/additional capital in small
EMPLOYER/BUSINESS ADDRESS Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name  Vacation/travel
business  Special events
 Tuition/Educational Expenses  Car repair
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code  Payment of utility/credit card bills  Health & wellness
 Purchase of appliance &
CITY HALL COMPOUND, BRGY. REAL, CALAMBA CITY, LAGUNA 4027 furniture/electronic gadgets
Housing Related
EMPLOYEE ID NUMBER DATE OF EMPLOYMENT SOURCE OF FUND  Others, specify
/
 Minor home improvement/home ______________
640 7533 07-29-2022 SALARY renovation/ upgrades
PREVIOUS EMPLOYMENT DETAILS FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)
EMPLOYER/BUSINESS NAME EMPLOYER/BUSINESS ADDRESS FROM (mm/yy) TO (mm/yy)

SIGNATURE OF APPLICANT PAYROLL ACCOUNT/DISBURSEMENT CARD

In the event of the approval of my application for Multi-Purpose Loan, I hereby authorize
Pag-IBIG Fund to credit my loan proceeds through my Payroll Account/Disbursement Card that 4292 5301 3812 7381
NAME OF BANK/BRANCH
I have indicated on the right portion.
UNIONBANK
APPLICATION AGREEMENT
In consideration of the loan that may be granted by virtue of this application subject to the pertinent provisions of the Implementing Rules and This office agrees to collect the corresponding monthly
amortization on this loan and the MS of herein applicant through
Regulations of Pag-IBIG Fund, I hereby waive my rights under R.A. No. 1405 (Secrecy of Bank Deposits Act) and authorize Pag-IBIG Fund to
salary deduction, together with the employer counterpart, and
verify/validate my payroll account/disbursement card. Furthermore, I hereby authorize my present employer,
remit said amounts to Pag-IBIG Fund on or before the 15th day
____________________________________________ or any employer with whom I may get employed in the future, to deduct the membership
of each month, for the duration that the loan remains
savings (MS) and monthly amortization due from my salary and remit the same to Pag-IBIG Fund. If the resulting monthly net take home pay after
deducting the computed monthly amortization on MPL falls below the monthly net take home pay as required under the GAA/company policy, I outstanding. However, should we deduct the monthly
amortization due from the applicant’s salary but failed to remit it
authorize Pag-IBIG Fund to compute for a lower loanable amount.
on due date, this office agrees to pay the corresponding penalty
I understand that should I fail to pay the monthly amortization due, I shall be charged with a penalty of 1/20 of 1% of any unpaid amount for every charged to applicant equivalent to 1/20 of 1% of any unpaid
day of delay. amount for every day of delay and penalty for non-remittance
If for any reason excess loan proceeds are erroneously credited to my payroll account/disbursement card, I hereby authorize Pag-IBIG Fund to equivalent to 1/10 of 1% per day of delay of the amount payable
debit/deduct the excess amount from my account without need of further notice of demand. Should my account balance be insufficient, the Fund from the date the loan amortization or payments fall due until
has the right to demand for the excess amount to be refunded. paid.
I authorize Pag-IBIG Fund to disclose, submit, share or exchange any of my account information to legal and government regulating agencies, other
banks, partner-merchants or third party in accordance with R.A. No. 9510 (Credit Information System Act), R.A. No. 10173 (Data Privacy Act of
2012), and other related or pertinent laws and regulations, as described in Pag-IBIG Fund’s Freedom of Information (FOI) Manual. The credit
information may also be transferred to service providers (e.g., Credit Information Corporation, Bankers Association of the Philippines - Credit __________________________________
Bureau), likewise in accordance with laws and regulations. AUTHORIZED SIGNATORY
I have read, understood and agree to be bound by the terms and conditions governing the eDisbursement Facility/Program and Pag-IBIG Fund’s (Signature Over Printed Name)
partner-banks’ internal guidelines.
Furthermore, I agree to participate in all current and future promotional activities conducted by the Fund.
_____________________________________
I certify that the information given and any or all statements made herein are true and correct to the best of my knowledge and belief. I hereby certify DESIGNATION
under pain of perjury that my signature appearing herein is genuine and authentic.

_____________________________________
REGINA A. DICHOSO
____________________________________
Pag-IBIG EMPLOYER ID NO.
Signature of Applicant Over Printed Name
PROMISSORY NOTE
For value received, I promise to pay on due date without need of demand to the order of Pag-IBIG Fund 5. I shall be considered in default in any of the following cases:
with principal office at BDO Life Megaplaza Building, 358, Sen. Gil Puyat Avenue., City of Makati the sum a. Any willful misrepresentation in any of the documents executed in relation hereto;
of Pesos: b. Failure to pay any three (3) consecutive monthly amortizations;
c. Failure to pay any three (3) consecutive membership savings;
(P_______________) Philippine Currency, with an interest at the rate of 1.4583% per month, including the d. Violation of any of the membership/STL/housing loan policies, rules, regulations, and
grace period, based on a diminishing balance method, and shall be amortized over the chosen term. guidelines of Pag-IBIG Fund.
6. In the event of default, the outstanding loan obligation shall become due and demandable. Without
I hereby waive notice of demand for payment and agree that any legal action, which may arise in relation the need for demand, the Fund shall offset the said outstanding loan obligation from my Total
to this note, may be instituted in the proper court of Makati City. Accumulated Value (TAV). However, in case my loan is in arrears but not in default, immediate
Finally, this note shall likewise be subject to the following terms and conditions: offsetting of my outstanding loan obligation shall be effected upon approval of my request, provided,
1. I shall pay the amount of Pesos: _______________________________ (P_______________) that it is based on any of the following justifiable reasons: Total disability or insanity; Separation from
through salary deduction, whenever feasible, over a period of one (1) year/two (2) years/three (3) service by reason of health; Death of borrower’s immediate family member; Distressed borrower due
years, with a grace period of two (2) months. In case I am unable to pay through salary deductions to unemployment limited to layoff and/or closure of company; Critical illness of the borrower or any
for any of the following circumstances, such as but not limited to, suspension from work; leave of immediate family member, as certified by a licensed physician under any of the following categories,
absence without pay; insufficiency of take home pay at any time during the term of the loan; or other subject to the approval of the Fund: cancer, organ failure, heart-related illness, stroke and
circumstances analogous to the foregoing, payments should be made directly to the Pag-IBIG Fund. neuromuscular-related illness; Repatriation of OFW borrower from host country and other meritorious
2. Payments are due on or before the 15th day of the month starting on _________________________. grounds as may be approved for by the Board.
3. Payments shall be applied according to the following order of priorities: Penalties, Interest and 7. In the event of membership termination prior to loan maturity, any outstanding loan obligation, shall
Principal. be deducted from my TAV and/or any amount due me or my beneficiaries that is in the possession of
4. A penalty of 1/20 of 1% of any unpaid amount shall be charged to me for every day of delay. the Fund. In case of my death, the outstanding obligation shall be computed up to the date of death.
Any payment received after date of death shall be refunded to my beneficiaries.
8. In case of falsification, misrepresentation or any similar acts committed by me, Pag-IBIG Fund shall
Signed in the presence of: automatically suspend my loan privileges indefinitely. I shall abide with all the applicable rules and
regulations governing this lending program that Pag-IBIG Fund may promulgate from time to time.
MYLA A.Witness
SALAMAT
________________________________ ALMA M. ELAZEGUI
________________________________

(Signature Over Printed Name)

Witness
(Signature Over Printed Name)
REGINA A. DICHOSO
__________________________________
Signature of Applicant Over Printed Name
*OTHER INFORMATION
How did you learn about the Pag-IBIG Multi-Purpose Loan (MPL)?
/
 Pag-IBIG Fund Website  Radio  Streaming Service Ad  Billboard  Referral  Others:
 Social media  Television  Newspaper/Online Newspaper  Word of Mouth  Employer/Fund Coordinator ______________________

AUTHORITY TO DEDUCT (Optional)

In case of retirement/separation from employment, I hereby authorize my employer to deduct any outstanding MPL balance from my retirement or separation SIGNATURE OF APPLICANT
benefits to fully settle my loan obligation. In the event that my retirement/separation benefits are not sufficient to settle the outstanding balance of my MPL or my
employer fails for whatever reason, to deduct the same from said retirement/separation benefits, I hereby authorize Pag-IBIG Fund to apply whatever benefits
are due me from the Fund to settle the said obligation.
THIS PORTION IS FOR Pag-IBIG FUND USE ONLY
RECEIVED BY: APPROVED/DISAPPROVED BY:

(SIGNATURE OVER PRINTED NAME) _____________ (SIGNATURE OVER PRINTED NAME) _____________
(POSITION/DESIGNATION) DATE (POSITION/DESIGNATION) DATE
THIS FORM CAN BE REPRODUCED. NOT FOR SALE.
 HQP-SLF-065
(V10, 05/2025)
GUIDELINES AND INSTRUCTIONS
A. Who May File
Any Pag-IBIG Fund member who satisfies the following requirements:
CERTIFICATE OF NET PAY 1. Has made at least twelve (12) monthly membership savings (MS);
▪ A member who has withdrawn MS due to membership maturity, or through optional withdrawal, may apply for an MPL
provided, that the member has subsequently accumulated 12 monthly MS or at least its equivalent, reckoned from the
cut-off date of membership maturity or optional withdrawal.
▪ A member, who does not meet the required 12 monthly MS may nevertheless, be allowed to avail of an MPL, provided
that the total accumulated savings is at least equivalent to 12 monthly MS, based on the rate applicable to the member.
2. Must be an active Pag-IBIG Fund member at the time of loan application;
3. If with existing MPL/Calamity Loan/HELPs, the account/s must not be in default as of date of application; and
4. Has sufficient proof of income.
REGINA A. DICHOSO B. How to File
NAME OF BORROWER The applicant shall:
1. Secure the Multi-Purpose Loan Application Form (MPLAF) from any Pag-IBIG Fund Branch or download from Pag-IBIG
website at www.pagibigfund.gov.ph.
2. Accomplish one (1) copy of the application form.
For the month of: _________________ 3. Submit the accomplished application form, together with the required documents to any Pag-IBIG Fund Branch. Processing
of loans shall commence only upon submission of the complete requirements.
C. Loan Features
1. Loan Amount
A qualified Pag-IBIG member shall be allowed to borrow an amount based on the lowest of the following:
Basic Salary _________________ 1.1 Desired Loan Amount
1.2 Loan Entitlement
The loan entitlement shall be equivalent to ninety percent (90%) of the member’s TAV. However, if the borrower has
Add: Allowances an existing MPL/Calamity Loan/HELPs, the loanable amount shall be the difference between the 90% of the
borrower’s TAV and the outstanding balance of the existing MPL/Calamity Loan/HELPs.
1.3 Capacity to Pay
_____________________ __________ The loanable amount shall be limited to an amount which will not render the borrower’s Net Take Home Pay (NTHP)
to fall below the minimum requirement as prescribed by the General Appropriation Act (GAA) or company policy,
whichever is applicable.
_____________________ __________ 2. Interest Rate
The loan shall be charged with an interest rate of 1.4583% per month, based on a diminishing balance method, with interest
during the grace period, and shall be amortized over the chosen term.
_____________________ __________ 3. Loan Term
The loan shall be repaid over a period of one (1) year, two (2) years or three (3) years, at the option of the member upon
loan application, with a grace period of two (2) months.
_____________________ __________ However, in the event that the borrower does not indicate the chosen loan term upon loan application, the default term
shall be two (2) years.
4. Loan Release
_____________________ __________ The loan proceeds shall be released through any of the following modes:
a) Crediting to the borrower’s disbursement card or Pag-IBIG Loyalty Card Plus;
b) Crediting to the borrower’s bank account through LANDBANK’s Payroll Credit Systems Validation (PACSVAL);
c) Check payable to the borrower. However, when the check remains unclaimed for a period of thirty (30) calendar days
_____________________ __________ from the DV/Check date despite notice to the borrower (either by email, registered mail or personal delivery to his
postal address, or Short Message Service (SMS) informing him that the same is available for release, the check shall
be cancelled and the loan will be reversed.
d) Other acceptable modes of disbursement.
5. Loan Payments
5.1 The loan shall be paid in equal monthly payments in such amounts as may fully cover the principal and interest over
Gross Monthly Income __________ the loan period. Said amortization shall be made, whenever feasible, through salary deduction.
5.2 For self-employed individuals, Overseas Filipino Workers (OFWs), or other types of individual payors, monthly
payments shall be paid over-the-counter or any other modes of payment approved by the Fund.
5.3 Payments shall be remitted to the Fund on or before the fifteenth (15 th) day of each month, starting on the third (3 rd)
month from the date indicated on the DV/Check or manual disbursement voucher.
Less: Deductions 5.4 If the due date falls on a non-working day, the monthly amortization shall be paid on the first working day after the due
date.
5.5 The borrower may fully pay the outstanding balance of the loan prior to loan maturity.
_____________________ __________ 5.6 The borrower shall pay directly to the Fund in case the borrower is unable to pay through salary deduction for any of
the following circumstances, such as but not limited to:
a. Suspension from work
b. Leave of absence without pay
_____________________ __________ c. Insufficiency of take home pay at any time during the term of the loan; or
d. Other circumstances analogous to the foregoing.
5.7 Payment shall be applied according to the following order of priorities:
_____________________ __________ a. Penalties; if any
b. Interest; and
c. Principal
_____________________ __________ 5.8 Any amount in excess of the required monthly amortization shall be applied to succeeding amortizations which will be
posted on the next due date.
6. Penalties
____________________ __________ A penalty of one-twentieth of one percent (1/20 of 1%) of any unpaid amount shall be charged to the borrower for every
day of delay. For borrowers paying through salary deduction, penalties shall only be reversed only upon presentation of
proof that non-payment was due to the fault of the employer. In such case, penalties due from the borrower shall be charged
to the employer. Non-remittance of the total loan amortization shall likewise subject the employer with a penalty of one-
_____________________ __________ tenth of one percent (1/10 of 1%) per day of delay of the amounts payable from the date the loan amortization or payments
Issued this _______ day of _________, 20__. fall due until paid.
I certify under pain of perjury that the above- 7. Default
The borrower shall be in default in any of the following cases, without need for demand:
mentioned information is true and correct. a. Any willful misrepresentation made by the borrower in any of the documents executed in relation hereto.
b. Failure of the borrower to pay any three (3) consecutive monthly amortizations.
Total Deductions __________ c. Failure of the borrower to pay any three (3) consecutive Pag-IBIG monthly savings; or
d. Violation by the borrower of any of the membership/STL/housing loan policies, rules, regulations and guidelines of
Pag-IBIG Fund.
D. ___________________________________________
Loan Renewal 8. Effects of Default
HEAD OF OFFICE/AUTHORIZED SIGNATORY In the event of default, the outstanding loan obligation shall become due and demandable. Without the need for demand,
E. Loan Renewal (Signature
over printed name) the Fund shall offset the outstanding loan obligation from the borrower’s TAV.
Net Monthly Income __________ D. Other Loan Provisions
1. The MPL, HELPs and Calamity Loan programs shall be treated as separate and distinct from one another. Accordingly, a
member may avail of an MPL even with an existing Calamity Loan/HELPs, and vice versa. Loan applications under these
programs shall be governed by their respective guidelines.
2. In no case shall the aggregate STL exceed ninety percent (90%) of the borrower’s TAV.
3. For all loan terms, a borrower may renew his/her MPL after payment of equivalent to four (4) monthly amortizations; not
earlier than sixth (6th) month after DV date of current loan; and provided that he/she meets the eligibility requirement. The
approved loan shall be applied to the borrower’s outstanding MPL obligation and the net proceeds shall then be released
Issued this ________ day of ____, 20___. to him. In case of full payment prior to loan maturity, a borrower shall be allowed to apply for a new loan anytime thereafter.
4. An eligible member who is an active member under more than one employer shall have only one outstanding MPL at any
given time. At point of application, the member shall choose which employer shall deduct and remit his monthly MPL
I certify under pain of perjury that the amortizations.
5. In the event of membership termination, any outstanding loan obligation whether current or in default shall be deducted
abovementioned information is true and from the borrower’s TAV and/or any amount due the member or the member’s beneficiaries that is in the possession of the
Fund. In case of the borrower’s death, the outstanding loan obligation shall be computed up to the date of death. Any
correct. payments received after date of death shall be refunded to the borrower’s beneficiaries.
6. Borrower may request for the immediate offsetting of an outstanding MPL balance against the borrower’s TAV.
The offsetting shall be effected upon approval of the request, provided, that it is based on any of the following justifiable
________________________________________ reasons: Total disability or insanity; Separation from service by reason of health; Death of borrower’s immediate family
AUTHORIZED SIGNATORY member; Distressed borrower due to unemployment limited to layoff and/or closure of company; Critical illness of the
borrower or any immediate family member, as certified by a licensed physician under one of the following categories:
(Signature Over Printed Name) cancer, organ failure, heart-related illness, stroke and neuromuscular-related illness; Repatriation of OFW borrower from
host country and other meritorious grounds as may be approved for by the Board.
7. If TAV offsetting has been effected on the borrower’s defaulting MPL, he may apply for a new MPL provided, he has paid
at least (6) monthly amortizations prior to default and its consequent offsetting against the borrower’s TAV, the member
may immediately apply for another loan, subject to the eligibility criteria provided in the Guidelines. However, if he has
paid less than six (6) monthly amortizations prior to default and its consequent offsetting against the borrower’s TAV, the
member may apply for a new loan only after one (1) year from the date of TAV offsetting, subject to the eligibility criteria
provided in the Guidelines.
8. In case there is a need to update the borrower’s address and/or contact details (i.e. present home address, permanent
home address, email address, cell phone number, home telephone number and business telephone number) at point of
loan application, the borrower shall not be required to submit Member’s Change of Information Form (MCIF, HQP-PFF-
049). The updating of information shall be based on the submitted MPLAF.
However, in case the information that needs to be changed/updated is other than the address and/or contact details, the
concerned borrower is required to submit the accomplished MCIF together with the supporting documents, if necessary.
Please refer to the Checklist of Requirements specified at the back portion of the MCIF.