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HQP-SLF-017

SHORT-TERM LOAN Pag-IBIG EMPLOYER’S ID NUMBER

REMITTANCE FORM (STLRF) 1234567890


NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.
EMPLOYER/BUSINESS NAME
A COMPANY
EMPLOYER/BUSINESS ADDRESS PERIOD COVERED
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name
MANILA DEC 2013
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code TELEPHONE NUMBER
MANILA 1234567
NAME OF BORROWER
APPLICATION/ EMPLOYER
MID No. LOAN TYPE AMOUNT
AGREEMENT No. Last Name First Name Name Ext. (Jr., III, etc.) Middle Name REMARKS

123456789 123456789 DELA CRUZ JUAN III A SALARY 10000 NONE

TOTAL FOR THIS PAGE 1000000


GRAND TOTAL (if last page) 1000000
EMPLOYER CERTIFICATION

I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best of my knowledge and belief. I further
certify that my signature appearing herein is genuine and authentic.

JOHN DOE
____________________________________________________ PRESIDENT
__________________________________ DEC 1, 2013
_________________________
HEAD OF OFFICE OR AUTHORIZED SIGNATORY DESIGNATION/POSITION DATE
(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE. (Rev. 00, 02/2013)
GUIDELINES AND INSTRUCTIONS

a. Type or print all entries in BLOCK or CAPITAL LETTERS. f. Failure to pay the amount due on or before due date, the concerned
employee shall be charged with a penalty, as prescribed in the guidelines.
b. Accomplish this form when making remittances to Pag-IBIG Fund or to any However, for employers who deducted the monthly installment from
th
accredited collecting agent on or before the fifteenth (15 ) day of the month. employee’s salary but failed to remit the same to the Fund on due date,
the penalties previously imposed to the employee shall be reversed and
c. A separate Short-Term Loan Remittance Form (STLRF [HQP-SLF-017]) shall be charged to the employer together with the penalty for non-
should be accomplished per type of payment (whether cash or check remittance equivalent to 1/10 of 1% per day of delay of the amounts
payment) and in case Credit Memo shall be applied as payment to the Fund. payable from the date the installment or payments fall due until paid.

d. In case there is a correction in the remittance which resulted to overpayment,


1 Pag-IBIG Employer’s ID No. – assigned Pag-IBIG Employer’s ID
the employer shall advise the Fund. Once validated, a Notice of
Number.
Overpayment and Credit Memo shall be issued to the employer. From the
date of issuance of the said Notice, the employer may request, not later than
six (6) months for refund of the excess amount or have it applied to future 2 Employer/Business Name – per DTI/SEC Registration.
remittance with the Fund.
3 Employer/Business Address – indicate Unit/Room No., Floor,
e. The total amount to be remitted should be equal to the total amount reflected
Building Name or Lot No., Block No., Phase No. or House No. and
on the STLRF. Check payments should be made payable to Pag-IBIG Fund
Street Name, Subdivision, Barangay, Municipality/City, Province,
and shall be posted upon clearing.
and ZIP Code.

4 Period Covered – indicate due date of the monthly installment in


the following format: yyyy/mm

1
5 Telephone Number – indicate current telephone number.

2 6 MID No. – indicate the borrower’s assigned Pag-IBIG Membership


Identification (MID) Number.
3 4

7 Application/Agreement No. – indicate the borrower’s loan


5
Agreement Number per type of loan.
6 7 8 9 10 11
8 Name of Borrower – indicate borrower’s complete name in the
following format: Last Name, First Name, Name Extension (Jr., III,
etc.), Middle Name

Loan Type– Indicate if payment is intended for Multi-Purpose Loan


9 (MPL) or Calamity Loan (CL) in the following format: MPL or CL

Amount – Indicate the amount due as indicated in the latest billing


10 statement.

11 Employer Remarks – accomplish this portion only to report


changes in the borrower’s employment status and to update any
information regarding the borrower. Indicate the appropriate code
and effectivity date in the following format (mm/dd/yy) on the space
provided. Please refer to the following codes and examples:

Examples
N - Newly Hired 1. N: 1/4/2013
L - Leave Without Pay/AWOL 2. L: 1/21/2013
RS - Resigned/Separated 3. RS: 1/3/2013
RT - Retired 4. D: 1/14/2013
D - Deceased
O - Others, please specify reason

12 Indicate the total amount due per page.

12
13 14 Indicate the grand total of the total amount due if this is the last
page.

Employer Certification – to be accomplished and duly signed by


15 15 the Head of Office/Authorized Signatory.