HQP-HLF-182

APPLICATION FOR CONVERSION (V03, 04/2018)

TO FULL RISK-BASED PRICING MODEL

Pag-IBIG MID Number/RTN Housing Account Number

(PRINT ALL ENTRIES IN BLOCK OR CAPITAL LETTERS.)

LOAN PARTICULARS
 Conversion to Full Risk-Based Pricing Model AVAILED OF RESTRUCTURING? DESIRED RE-PRICING PERIOD (in years) MODE OF PAYMENT  Collecting Agent
 Changed in Fixed Pricing Period  Yes  No  3 5  10  15  20  25  Salary Deduction  Bank
 Over-the-Counter  Developer
 WITH PDC  WITHOUT PDC WITH ADDITIONAL LOAN? IF WITH ADDITIONAL LOAN, RE-PRICING SHALL BE APPLIED ON? Cash/Check  Remittance
 Yes  No  Original Loan only  Both loans  Additional Loan only Post-Dated Checks Center
PROPERTY LOCATION
Unit/Room No., Floor Building Name Lot No., Blk No., Phase No., House No. Street Name

Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code

BORROWER’S DATA
LAST NAME FIRST NAME EXTENSION NAME 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/  Legally  Annulled
Unmarried Separated
 Married  Widow
Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code
CONTACT DETAILS (Indicate country code if
abroad)
PRESENT HOME ADDRESS COUNTRY + AREA CODE TELEPHONE NO.
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name Home

Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code Cell Phone

Email Address
HOME OWNERSHIP YEARS OF STAY IN PRESENT HOME EE SSS/GSIS ID No.
 Owned  Company  Living w/ relatives/parents ADDRESS
 Mortgaged  Rented at P__________/mo. CONTACT DETAILS (Indicate country code if
OCCUPATION EMPLOYER/BUSINESS NAME (If self-employed) TIN abroad)
 Employed COUNTRY + AREA CODE TELEPHONE NO.
 Self-Employed Business (Direct Line)
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No Street Name Business (Trunk Line)

Subdivision Barangay Municipality/City Province and State Country (if abroad) Zip Code Employer/Business Email Address

SPOUSE’S PERSONAL DATA

LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME 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.

CERTIFICATION
I/We certify that the foregoing information/statement is to my/our knowledge, true, correct, complete, and updated. The signature/s appearing above my/our
printed name/names below is/are genuine.
I/We authorize 1) Pag-IBIG Fund or its duly authorized representative to regularly submit and disclose my/our credit data (as defined under Republic Act
No. 9510 and its Implementing Rules and Regulations) to Credit Information Corporation (CIC) as well as any updates or corrections thereof; and to send me/us
updates about my/our housing loan application/account via SMS/text, email, mail or other available means of communication; and 2) CIC to share my/our credit
data with accessing entities, special accessing entities, outsource entities and data subjects, in accordance with the Implementing Rules and Regulations of
Republic Act No. 9510.
I/We 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/We agree to
notify Pag-IBIG Fund of any material change affecting the information contained herein. I/We agree that all information obtained by Pag-IBIG Fund shall remain
its property whether the application has been granted or not.
I/We further agree to be bound by the current and general policies of Pag-IBIG Fund and those that the Pag-IBIG Fund may adopt in the future, that may
have relation to or in any way affect my/our loan.

I/We understand that the processing/service/filing fee, notarial and all other fees shall be for my/our account.

_____________________________________________ ___________________________________________
SIGNATURE OF BORROWER OVER PRINTED NAME SIGNATURE OF SPOUSE OVER PRINTED NAME
____________________________________ ____________________________________
DATE DATE
FOR PAG-IBIG FUND USE ONLY
COMPLIES ELIGIBILITY REQUIREMENT  YES  NO
VERIFIED BY DATE APPROVED BY DATE DISAPPROVED BY DATE

REMARKS

THIS FORM CAN BE REPRODUCED. NOT FOR SALE.

 HQP-HLF-182
(V03, 04/2018)

GUIDELINES AND INSTRUCTIONS

A. WHO MAY FILE

Any Pag-IBIG Fund borrower whose accounts were taken out under Circular No. 247 or earlier Circulars or were
restructured under Circular No. 300 or earlier Circulars as of date of application provided;
 The borrower’s housing loan account is updated. Borrowers whose accounts are in arrears shall be required to
fully update their accounts.
 The borrower must be an active Pag-IBIG member.
 Updated real estate tax payment.

B. HOW TO FILE

The applicant shall:

1. Accomplish application form for Conversion to Full Risk-Based Pricing Model (HQP-HLF-182).
2. Pay service Fee.
3. Submit completed application form, together with the required documents to any Pag-IBIG Branch. Processing
of application shall commence only upon submission of complete documents.

C. BASIC REQUIREMENTS (UPON APPLICATION)

1. Duly accomplished Application for Conversion to Full Risk-Based Pricing Model (HQP-HLF 182, 2 copies).
2. Updated Real Estate Tax Receipt for Land and Building (photocopy).
3. Special Power of Attorney and two (2) valid ID cards each of the Principal and Attorney-In-Fact (If borrower,
borrower spouse, co-borrower and co-borrower spouse, if any, cannot file personally)
Note: Notarized SPA for an OFW, prior to date of departure or for an OFW member in abroad, a notarized SPA
by a Philippine Consular Officer, or by a local notary (of the country where the member is working) but
duly authenticated by the Philippine Consulate.
4. For changed of marital status, photocopy of the following:
a. Single to married
 Marriage Contract with Registry Number issued by Philippine Statistics Authority (PSA)
b. Married to single
 Court Order
c. Widowed
 Death Certificate of deceased spouse

D. REQUIREMENTS UPON APPROVAL

1. Notarized Promissory Note (HQP-HLF-181, 4 copies).

2. Authority to Deduct (HQP-HLF-124) if applicable.
3. Replacement of Post-Dated Checks, if applicable.
4. Photocopy of Two (2) valid ID’s of borrower and one (1) valid ID of spouse, if applicable.

NOTE: IN ALL INSTANCES WHEREIN PHOTOCOPIES ARE SUBMITTED, THE ORIGINAL DOCUMENT MUST
BE PRESENTED FOR AUTHENTICATION.