HQP-PFF-093

(V04, 01/2019)

REQUEST FOR CONSOLIDATION/

MERGING OF MEMBER’S RECORDS

June 23, 2022

________________
Date

Dear Sir/Madam:

I would like to request for the consolidation/merging of my membership records with the
following information:

Pag-IBIG MID Number : 106001986926

Member’s Name
Present Home Address
Marital Status
Contact Number
Employer/Business Name
Employer/Business Address
Employer/Business Contact No.
Purpose of Consolidation/Merging
________________________________________________
: Hernandez Reynald Miranda
________________________________________________
Last Name First Name Name Extension Middle Name
: 187 Barangay Mabini, Sta. Rosa, Nueva Ecija
________________________________________________
________________________________________________
________________________________________________
:  Single/Unmarried  Widow/er  Annulled
 Married  Legally Separated
: 09550498484
________________________________________________
: Hernandez Property Leasing (Self Employed)
________________________________________________
: 187 Barangay Mabini, Sta. Rosa, Nueva Ecija
________________________________________________
: 09550498484
________________________________________________
:  Short-Term Loan (STL) Application
 Application for Provident Benefits Claim
Continuation of Contribution
 Others, please specify _________________________________

Previous Employer/Business Name Previous Employer/Business Address Inclusive Date(s)

1. Pandayan Bookshop Poblacion, Sta. Rosa, Nueva Ecija May 2008 - October 2008
2. Manson Drug NE Pacific Mall, Cabanatuan City February 2007 - April 2007
3.
4.
5.

Requesting Pag-IBIG Fund Branch: ______________________________

Requested by: Processed by:

Reynald Hernandez
_______________________________ __________________________________
Member’s Name and Signature Name and Designation of Authorized Signatory

Approved by:

__________________________________
Name and Designation of Authorized Signatory