Fill up the form below. Fields marked * are required.

*Email Address:
*Confirm Email Address:
*Card Number:
Enter your 16-digit HappyPlüs card number.
*Password:
Password must have at least 8 characters.
*Re-enter Password:
Password must have at least 8 characters.
*First Name:
*Middle Name:
*Last Name:
*Gender:
Civil Status:
Birth Date:
*Mobile Number:
e.g. 09171234567 or 639181234567 or +639201234567
*Landline Number:
e.g. 021234567, area code is optional
Additional Contact Number:
Additional Contact Number:
Mailing Address:
Unit/House Number: Building Name: *Street: Subdivision/Barangay: *City: