Agency Name: DEPED BINAN WEST Agency BP Number: 1000001141

FOR AGENCY REMITTANCE ADVICE

FORM A. List of employees with life and retirement premium remittance but without existing record in the GSIS Database.
Mailing Basic Address / Zip Cellular Monthly Middle Name Code Phone no. Email Address Sex CS Date of Birth Place of Birth Salary PAGUNTALAN B13 L26 MACOPA ST. SOUTH PLAIN I SUBD.F +639392736832 NONE BRGY. STO. TOMAS, BIAN CITYQUEZON CITY MARRIED May28,1963 4024 14,198.00 MALABAN ELEM. SCHOOL, MALABAN, BIAN CITY 4024 +639212923893 marella_009@yahoo.com F SINGLE October17,1985 CASTILLA, SORSOGON 14,026.00 NATUEL MALABAN EAST+639194501975 ILAYA, MALABAN, BIAN CITY 4024 ELEM. SCHOOL, joelolitin@yahoo.com MARRIED October17,1979 GUINOBATAN, ALBAY M 14,198.00 ARMIA ROSAL ST. BATISTA SUBD. SAN JOSE, BIAN CITY 4024 +639208602543 NONE F MARRIED ### MAGDALENA,15,733.00 LAGUNA BACANTO P11 B7 L22 PROGRESSIVE VILLAGE, TAGAPO, STA. ROSA CITY 4026 +639329257113 NONE F MARRIED ### BIAN CITY 15,199.00 PELINGON B10 L3 MONDO BAMBINI, BRGY. PLATERO, JUBILATION, NEW BIAN, BIAN CITY 4024 +639274856463 F MARRIED August29,1977 ANTIQUE 14,483.00 l_pelingon@yahoo.com Status of Effectivit Employmen y Date Position t 2/8/2008 TEACHER 1 ERMANENT P 7/1/2009 TEACHER 1 ERMANENT P 1/10/2005 TEACHER 1 ERMANENT P 7/1/2009 TEACHER 2 ERMANENT P 7/1/2009 TEACHER 2 ERMANENT P 9/17/2003 TEACHER 1 ERMANENT P

Last Name SANTOS MARBELLA OLITIN COSICO ESTRELLA MIRANDA

First Name SOCORRO LYSEL JOEL NENITA GLENDA LORNA

Suffix

If any or all of the employees listed above are new employees in that Agency, please provide the above information in the appropriate column.

Agency Name: DEPED BINAN WEST Agency BP Number: 1000001141

FOR AGENCY REMITTANCE ADVICE

FORM A. List of employees with life and retirement premium remittance but without existing record in the GSIS Database.
Mailing Basic Address / Zip Cellular Monthly Middle Name Code Phone no. Email Address Sex CS Date of Birth Place of Birth Salary PAGUNTALAN B13 L26 MACOPA ST. SOUTH PLAIN I SUBD.F +639392736832 NONE BRGY. STO. TOMAS, BIAN CITYQUEZON CITY MARRIED May28,1963 4024 14,198.00 MALABAN ELEM. SCHOOL, MALABAN, BIAN CITY 4024 +639212923893 marella_009@yahoo.com F SINGLE October17,1985 CASTILLA, SORSOGON 14,026.00 NATUEL MALABAN EAST+639194501975 ILAYA, MALABAN, BIAN CITY 4024 ELEM. SCHOOL, joelolitin@yahoo.com MARRIED October17,1979 GUINOBATAN, ALBAY M 14,198.00 ARMIA ROSAL ST. BATISTA SUBD. SAN JOSE, BIAN CITY 4024 +639208602543 NONE F MARRIED ### MAGDALENA,15,733.00 LAGUNA BACANTO P11 B7 L22 PROGRESSIVE VILLAGE, TAGAPO, STA. ROSA CITY 4026 +639329257113 NONE F MARRIED ### BIAN CITY 15,199.00 PELINGON B10 L3 MONDO BAMBINI, BRGY. PLATERO, JUBILATION, NEW BIAN, BIAN CITY 4024 +639274856463 F MARRIED August29,1977 ANTIQUE 14,483.00 l_pelingon@yahoo.com Status of Effectivit Employmen y Date Position t 2/8/2008 TEACHER 1 ERMANENT P 7/1/2009 TEACHER 1 ERMANENT P 1/10/2005 TEACHER 1 ERMANENT P 7/1/2009 TEACHER 2 ERMANENT P 7/1/2009 TEACHER 2 ERMANENT P 9/17/2003 TEACHER 1 ERMANENT P

Last Name SANTOS MARBELLA OLITIN COSICO ESTRELLA MIRANDA

First Name SOCORRO LYSEL JOEL NENITA GLENDA LORNA

Suffix

If any or all of the employees listed above are new employees in that Agency, please provide the above information in the appropriate column.

Agency Name: DEPED BINAN WEST Agency BP Number: 1000001141

FOR AGENCY REMITTANCE ADVICE

FORM A. List of employees with life and retirement premium remittance but without existing record in the GSIS Database.
Mailing Address / Zip Cellular Suffix Middle Name Code Phone no. Email Address Sex CS Date of Birth GONZALES NATIONAL HI-WAY +639178870888 F MARRIED October30,1980 joie_anido@yahoo.com VELASCO #0004 M.E MALAYAN ST. MALAYAN SUBD. MALABAN, BIAN CITY 4024 +639398466624 NONE F MARRIED April6,1979 BUENASEDA B6 L9 EVERGREEN COUNTRY, ZAPOTE, BIAN CITY 4024 +639165290252 joharnio8@yahoo.com F MARRIED April25,1981 TONGGA CHUMPACA ST. +639174407736 SAN JOSE, NONE CITY 4024 BIAN F SINGLE December6,1984 CAPADOCIA CASTRO DE #86 ALMEDA SUBD. DELA PAZ, BIAN CITY F +639087653447 aliceshymie@yahoo.com.ph 4024MARRIED May7,1980 ILAN #2691 ALMEDA SUBD. DELANONEBIAN CITY 4024 +639272065276 PAZ, F MARRIED March29,1982 Basic Status of Monthly Effectivit Employmen Place of Birth Salary y Date Position t STA. CRUZ, LAGUNA 14,198.00 6/1/2009 TEACHER 1 ERMANENT P LABO, CAMARINES NORTE 14,198.00 12/5/2007 TEACHER 1 ERMANENT P LUISIANA, LAGUNA 14,198.00 6/5/2006 TEACHER 1 ERMANENT P BIAN CITY 12,026.00 6/10/2008 TEACHER 1 ERMANENT P BIAN CITY 14,483.00 1/14/2002 TEACHER 1 ERMANENT P CAMARINES NORTE 14,198.00 6/16/2008 TEACHER 1 ERMANENT P

Last Name ANIDO TULAGAN CAMERINO MIRANDA FAJARDO ABRERA

First Name JOZERELLA AMELIA JULIE ANN MYLENE ALICE JOHNELLIE

If any or all of the employees listed above are new employees in that Agency, please provide the above information in the appropriate column.

If any or all of the employees listed above (FORM A) are transferees, please provide the information required in Form B below opposite their name. Agency Name: Agency BP Number: DEPED BINAN WEST ###

FOR AGENCY REMITTANCE ADVICE

FORM B. List of Transferees
Member BP Number Date of Transfer 4/22/2010 Employment Position status TEACHER 1PERMANENT

Last Name RUGERIA

First Name MYLENE

Suffix

MI ORDIALES

Salary 14,198.00

Agency Name: Agency BP Number:

DEPED BINAN WEST ###

FOR AGENCY REMITTANCE ADVICE

FORM C. List of employees with salary adjustments for confirmation as to correct amount of monthly salary and effectivity date to be supplied below.
Member BP Number Employment status

Last Name

First Name

Suffix

MI

Salary

Effectivity Date

Position

Agency Name: Agency BP Number:

DEPED BINAN WEST ###

FOR AGENCY REMITTANCE ADVICE

FORM D. List of employees with no premium remittance for 2 consecutive months.
Member BP Number

Last Name

First Name

Suffix

MI

Reason 1

Effectivity Date

Remarks 2

1 Reason: please specify whether transferred to other office / resigned / retired / deceased / dismissed / laid-off / end of term / end of contract / dropped from the rolls / suspended / on Leave without pay, etc. 2 Remarks: in case transferred to other office, please indicate new office (if available)

Agency Name: Agency BP Number:

DEPED BINAN WEST 1000001141

FOR AGENCY REMITTANCE ADVICE

FORM E. List of employees with changes / correction in their Personal Data
Last Name From To SANTIAGO PERALTA 80070500268 HILVANO TAN ERISPE ESPERIDO 77082900899 PELINGON MIRANDA DE CASTRO VILLALON Member BP Number First Name From To PRINCESITA SEMEONA ANNA FE LORNA MARIA LUISA Suffix From To Middle Name From To QUISIQUISI SANTIAGO REPOSO HILVANO ERISPE PAGUNALING PELINGON CAPADOCIA DE CASTRO Mailing Address / Zip Code Cellular Phone no. From To From To #95 MARIVEL SUBD. CANLALAY, BIAN CITY 4024 +639166441691 373 STO. NIO, BIAN, LAGUNA / 4024 Email Address From To NONE

B 10 L 3 MONDO BAMBINI BRGY. PLATERO, JUBILATION NEW BIAN, BIAN CITY, LAGUNA, 4024 09274856463 l_pelingon@yahoo.com B 2 L 2 SOUTH ST. VILLA DE JESUS STA. ROSA, LAGUNA

* For Change of date of birth please attach scanned copy of Original NSO authenticated Birth Certficate

Civil Status From To SINGLE MARRIED SINGLE MARRIED SINGLE MARRIED SINGLE MARRIED SINGLE MARRIED

Date of Birth * From To April11,1975

Place of Birth From To CANLALAY, BIAN CITY

Position / Title From To TEACHER 1

Status of Employment From To PERMANENT