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Pagibig - Form

Pagibig - Form

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Published by Tiffany Malata

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Published by: Tiffany Malata on Feb 22, 2012
Copyright:Attribution Non-commercial

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09/10/2012

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MEMBERSHIP REGISTRATION/REMITTANCE FORM
Pag-IBIG Fund
M1-1
(Please read instructions at the back)
NAME OF EMPLOYERADDRESS OF EMPLOYERFOR PRIVATEEMPLOYEREMPLOYER SSS NO.FOR GOV’TEMPLOYERMONTHYEARAGENCYCODEBRANCHCODEREGIONCODETINZIP CODETELEPHONE NO/S.
C O N T R I B U T I O N S
1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.26.27.28.29.30.31.32.33.34.35.36.37.38.39.40.
No. of Employeeson this pageTotal No.of Employeesif last page
FOR Pag-IBIG USE ONLY
PFR/VALIDATION No.COLLECTING BANKTICKET DATEMMDDYYDATEMMDDYYRECONCILED BYAMOUNTREMARKSCHECKED BYP
TINNAME OF EMPLOYEES
(Family NameFirst NameMiddle Name)
EMPLOYEEEMPLOYERTOTAL
TOTAL FORTHIS PAGEGRAND TOTAL(if last page)
CERTIFIED CORRECT BY:
SIGNATURE OVER PRINTED NAMEOFFICIAL DESIGNATIONDATE
PAGE NO.NO. OF PAGES
PPPPPP
PRIVATE EMPLOYER
LOCAL GOVERNMENT UNIT
GOVERNMENT CONTROLLED CORP.
NATIONAL GOVERNMENT AGENCY
NOTE:
NEW REGISTRANTS SHALL PROVIDE TIN AND DATE OF BIRTH 
THIS FORM CAN BE REPRODUCED. NOT FOR SALE
(Revised 05/2003)
DATE OF BIRTH

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