FPF400

REQUEST FOR TRANSFER OF MEMBER'S RECORDS AND LOAN DETAILS (RTMRLD) _____________________ Date Dear Sir/Madam: I would like to request transfer of my membership records and loan details to the _________________ with the following information: Name of member: Last Name

First Name

θ Single θ Married θ Widow/er

Civil Status:

Name Extensions (Jr., Sr., II, etc.)

Middle Name (Maiden)

θ Legally Separated θ Annulled

Home Address: Telephone No.: Present Company/Employer: Company/Employer Address: Telephone No.: Purpose of Transfer:

Check if with: θ Housing Loan Takeout date Loan Status Outstanding Balance

Company ID No.: θ Claims θ STL θ Others, pls. Specify _____________

: : :

Name of Previous Company/Employer

θ Consolidation μ Intra-branch (within the branch) μ Inter-branch (among branches)

θ STL DV/Check Date Loan Status Outstanding Balance

: : :

Company/Employer Address/Contact No.

Inclusive Date(s)

1. 2. 3. 4.

Requesting Pag-IBIG Fund Branch: ______________________________

Requested by: Processed by: ___________________________________ Member's Signature Over Printed Name

Noted by: Revised 08/2008