HQP-WLF-252

(V01, 01/2023)

BUYER CONFIRMATION FORM

NAME OF PROJECT PROPONENT JURIDICAL PERSONALITY

 LGU  Employer  Employees’ Association
 Cooperative  Other Group/s, pls specify
NAME OF PROJECT BENEFICIARY
LAST NAME FIRST NAME EXTENSION NAME MIDDLE NAME

DATE OF BIRTH (mm-dd-yyyy) MARITAL STATUS

 Single/Unmarried  Widow/er  Annulled
 Married  Legally Separated
MOTHER’S MAIDEN NAME EMPLOYMENT STATUS
 Permanent  Casual
 Temporary  Others, pls. specify
PRESENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name CONTACT NUMBER
Home
Subdivision Barangay Municipality/City Province/State/Country (if abroad)
Cell Phone

COMPANY/EMPLOYER/BUSINESS NAME Business (indicate local, if any)

Personal Email Address

COMPANY/EMPLOYER/BUSINESS NAME ADDRESS

NAME OF SPOUSE
LAST NAME FIRST NAME EXTENSION NAME MIDDLE NAME

SPOUSE’S COMPANY/EMPLOYER/BUSINESS NAME

SPOUSE’S COMPANY/EMPLOYER/BUSINESS ADDRESS

MONTHLY SALARY (Basic + Allowances) P

SPOUSE’S MONTHLY SALARY (Basic + Allowance) P

PARTICULARS

Do you have other sources of income aside from salary?  Yes  No (If yes, please specify)
Source of Additional Income

Average Monthly Additional Income P

If you will be granted a Pag-IBIG Housing Loan, how much can you afford to pay as your monthly amortization?

P _____________.

Are you a Pag-IBIG member?  Yes  No

(If yes, indicate Pag-IBIG MID No. ________________)
Have you availed of a Pag-IBIG housing loan?  Yes  No
Have you been a co-borrower of a Pag-IBIG housing loan?  Yes  No
Do you wish to pursue your housing loan application with the Project Proponent?  Yes  No
Have you been informed of the terms and conditions of your loan?  Yes  No

Details of Preferred House/Unit Model

House/Unit Model :

Selling Price : P

Monthly Amortization : P

I hereby certify that the foregoing information/statement is, to the best of my knowledge, true, correct and complete. I
authorize Pag-IBIG Fund to share my/our personal information and other details of my/our loan account with other
government agencies and third parties, as may be necessary in the processing of my housing application, subject to the
limits under Republic Act No. 10173 (Data Privacy Act of 2012), and its Implementing Rules and Regulations. Further, I/we
promise to notify Pag-IBIG Fund of any amendments or changes in my/our personal information indicated herein.

Likewise, I certify that I have been reminded by the Pag-IBIG Fund/Project Proponent’s authorized representative on
Pag-IBIG policies on housing loan take-out, monthly amortization, modes of payment and due date, penalty rate, and
consequence of default and I am willing to pursue to my housing loan application to purchase the property.

____________________________________ ______________
Signature of Project Beneficiary Over Printed Name Date