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 Name Extensions (Jr., Sr., II, etc.) Middle Name (Maiden)
Civil Status:
Single Married Widow/er
Legally Separated Annulled
Home Address: Telephone No.: Present Company/Employer: Company/Employer Address: Telephone No.: Purpose of Transfer: Company ID No.: Claims STL Others, pls. Specify _____________ Consolidation Intra-branch (within the branch) Inter-branch (among branches)
Check if with: Housing Loan Takeout date Loan Status Outstanding Balance
: : :
STL DV/Check Date Loan Status Outstanding Balance
: : :
Name of Previous Company/Employer 1. 2. 3. 4.
Company/Employer Address/Contact No.
Inclusive Date(s)
Requesting Pag-IBIG Fund Branch: ______________________________
Requested by: Processed by: ___________________________________ Member's Signature Over Printed Name Noted by:
Revised 08/2008