MODIFIED Pag-IBIG I op.PFF-226 (vos, 09/2019) | ENROLLMENT FORM TOR Pg 616 FOND USE ONT 5233 2800 5836 ‘Tomo RACHELLE MAE CAMPICERIO 1213 1970 7013 PRESENT HOME ADDRESS Unw/ioanvie, fear Galng ons ete, Beatie, PhaeheHoureNaSeeetWone | DATE OF BIRTH Sshavson Swanger noi Proves oone if abe) ‘ze cade [CONTACT DETALS EMPLOVER/BUSINESS NAME fonniab) a Oe EMPLOFESUSNESSADDRESS avon, fer iphone Lt, ae, Pet anne Settane PENMAN | |_ eawsn ‘angay Manan ‘reve oie ebro aca ‘SOURCE OF FUNDS PREFERRED DIVIDEND PAYOUT MPLOYMENT INCOME LoaN [MATURITY/SURRENDER OF LIFE POLICY | ANNUALY SAVINGS/DEPOSTTS COMPANY SALE OTHERINCOME SOURCES fivesvean eno ream) PROPERTY SNE Conan PROFITs/OWIDENDS FOR LOCALD-EMPLOYED MEMBERS Te [MODE OF PAYMENT TH TO AUIRORZE MY PRESENT AND FUTURE EMPLOYER TO DEDUCT MW MP2 MONTHLY SAVINGS IN TH \MOUNT OF ONE THOUSAND PESOS (Pi000.00 | FROM MY SALARY AND REMIT THE SAME TO Fag 1G FUND. ‘SGRATURE OVER PRINTED WANE ‘SALARY DEDUCTION (OVER-THE-COUNTER (OTC) (oton P0181 Fun art) THRU ANY ACCREDITED Pag-B1G COLLECTING PARTNERS "TERMS AND CONDITIONS hereby cer that ful understand the program and agree tothe Following terms and conditions 1. The m2 proram shal be voluntary forthe following: 112 Pensioners, egardles of age, witha least 28 monthly savings prior ta reiement 2. the enrollment under hs program shall be solely a savigs scheme 5. The minimum savings 800.00 which shal be recorded 35 of payment date. However, should | make 2 one-time cantrbuton that ‘exceeds P500,000.0, shall be required to make such payment via personal or Managers Check 4.The MP2 account sal e entitle to enibie dividend rates higher than that of Pag181G wich shall be declare ater the net income has been computed and approved by the Bard of Trustees 5.1 may opt to have an annual dvidend payout er compounded dividend exrrings 16.The membership term shall be ve (5) years reckone from date of inal payment of savings under tis program. 7. Upon maturity, shoul decide to continue my aaiiment of MP2 {id not withdraw upon maturty, lunderstane that my MP2 savings Shalleease to ear duidend provided under MP2 program. Instead, "Assubsequentdidends shal be based onthe ates deloed for agiG I forthe next two (2) years. Thereafter shall be reclassified a payable account 8 Pretermnation or withdrawal of MP2 savings prior to maturity shal be allowed under any ofthe following circumstances, a applicable: 81 Total esablty or insanity: |urther certify under pan of perjury thatthe information given and any or all tate ry signature appearing herein s genuine and authentic 2 Separation from service by reason of health; 183 Death ofthe member or any af his/her immeciate fay member; 184 Reierent; 185 Permanent departure from the countrys Bo Distressed member due to unemployment fnited to lyol anor closure of company; £8, rial less of the member of any of his immediate family members, a defined under pertinent Guidelines as cet by 3 leensed physician under ofthe fllowing etegoies, subje aoproval “organ Fall; “Heart-reate ness; “stroke “ Nevromuscuarrelated iss. {88 Repaviation of OFW member rom host county £89 Other mertorious ground 3s maybe approved for bythe Boars £8.10 Circumstances under tems 82, 84,86 and 8 Bare exclusively applicable to Pag IG I members 8. Shou opt to pre:terminate my MP2 membership for eason/s other 9.11 shall nly be entitled to 50% ofthe total dividend earned as penalty fr the pre-termination of MP2 savings: oF 9.21 opted forthe annual dividend payout! shal en eesve my 10. ease of any change In nfermation, | shall accomplish the ‘Member's Change of Information Form {MCF and immediately notify Pag8iG Fund, tment made herein are true and correct tothe best of my knowledge and belt and that ‘SIGNATURE OVER PRINTED NAME aE