AAO Manual Annex C - Enrollement Form

PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN
(GOVERNMENT SERVICE INSURANCE SYSTEM)

Financial Center, Pasay City, Metro Manila 1308
ELECTRONIC ONLINE SYSTEM ENROLLMENT FORM
X
Agency Authorized Officer Data Sheet

New
Office Name OFFICE OF THE CITY TREASURER
Agency BP No
Office Address N.S. VALDEROSA ST., CITYHALL, ZAMBOANGA CITY
GSIS ID No
Last Name
Renewal
First Name
Middle Name
Agency Authorized Officer Contact Details
Cell Phone Number
Office Telfax1 Number with area code 062- 991-2189
Office Telfax2 Number with area code N/A
Email Address N/A
Agency Authorized Officer Mothers Maiden Name Information
Mothers Maiden Last Name
Mothers Maiden First Name
Mothers Maiden Middle Name
Signatures of Requesting Agency Officers
Agency Authorized Officer:
(Printed Name)
Indorsing Officer:
SOLEDAD L. LI/CITY TREASURER
(Printed Name / Designation)
We understand that by affixing our signatures on the above, authorization when granted, is specific to
the office specified in this application form. Moreover, it will be automatically disabled after one year
should no request for renewal is received by the GSIS prior to expiry.
Please Do Not Fill-Up. For GSIS Use Only
Reviewed by GSIS Accounts Management Staf
Date Accomplished
Approved by GSIS Department Manager
Date Accomplished
Action Taken
Initial & Date
Authorization Enabled
Authorization Not Enabled
Notes:
1. All boxes MUST be filled up (Type or Print).
2. Authorizations are valid only for one year and MUST BE RENEWED by re-applying using this form.

X
New
Agency BP No
GSIS ID No 4808310322
Last Name AGUIDAN
First Name REYNALDO
Middle Name EIJANSANTOS
Renewal

Cell Phone Number 0917914352
Office Telfax1 Number with area code 062- 991-2189
Email Address N/A
Mothers Maiden Last Name ARANETA
Mothers Maiden First Name EDNA
URO

IRA LEVIN A. FILOTEO
(Printed Name)
Indorsing Officer:
Date Accomplished
AUGUST 6, 2009
Date Accomplished
AUGUST 6, 2009

Date Accomplished
Date Accomplished
Action Taken
Initial & Date
Notes:

Financial Center, Pasay City Metro Manila 1308
AAO ELECTRONIC ONLINCE SYSTEM FORM
NEW
Renewal
Termination

Agency BP No.
GSIS Old ID No./BP No. 4808310322
Last Name Aguidan
First Name Reynaldo
Middle Name Eijansantos
Cell Phone Number: 9177233078
Office Telfax1 Number with Area Code
062-991-2189
N/A
Email Address N/A
Agency Authorized Officer Mother's Maiden Name Information
Mother's Maiden Last Name Eijansantos
Mother's Maiden First Name Perfecta
Mother's Maiden Middle Name Locson
( ) Primary
REYNALDO E. AGUIDAN
Signature over Printed Name
Indorsing Officer:
Asst. City Treasurer

Designation/Position
SOLEDAD L. LI
CITY TREASURER
( ) Alternate
Date Accomplished
Date Accomplished
We understand that by affixing our signatures on the above, authorization when granted, is speciifc to the office
specified in this application from. Moverover, it will be disabled after GSIS received request for termination.
Please Do Not Fill-up. For GSIS Use Only
Reviewed by GSIS Accounts Management Staff
Date Accomplished
Action Taken
Initial & Date

Authorization Disabled

Financial Center, Pasay City Metro Manila 1308
AAO ELECTRONIC ONLINCE SYSTEM FORM
NEW
Renewal
Termination

Agency BP No.
GSIS Old ID No./BP No.
Last Name CANDIDO
First Name ROMELITA
Middle Name FALCASANTOS
Cell Phone Number: 0917-523-2767
062-991-2189
N/A
Email Address rfc_cto@yahoo.com
Agency Authorized Officer Mother's Maiden Name Information
Mother's Maiden Last Name FALCASANTOS
Mother's Maiden First Name CARMEN
Mother's Maiden Middle Name MARCOS
( ) Primary
ROMELITA F. CANDIDO
Indorsing Officer:
SOLEDAD L. LI
CITY TREASURER
9/2/2013
Date Accomplished
( ) Alternate
Date Accomplished
We understand that by affixing our signatures on the above, authorization when granted, is speciifc to the office
specified in this application from. Moverover, it will be disabled after GSIS received request for termination.
Please Do Not Fill-up. For GSIS Use Only
Reviewed by GSIS Accounts Management Staff
Date Accomplished
Action Taken
Initial & Date

Authorization Disabled

X
New
Agency BP No
GSIS ID No 4808310322
Last Name AGUIDAN
First Name REYNALDO
Middle Name EIJANSANTOS
Renewal

Cell Phone Number 09177233078
Office Telfax1 Number with area code 062-991-2189
Email Address N/A
Mothers Maiden Last Name EIJANSANTOS
Mothers Maiden First Name PERFECTA
LOCSON

REYNALDO E. AGUIDAN
(Printed Name)
Indorsing Officer:
Date Accomplished
January 1, 2011 - December 31,
2011
Date Accomplished
January 1, 2011 - December 31,
2011
Date Accomplished
Date Accomplished
Action Taken
Initial & Date
Notes:
Republic of the Philippines
Office of the City Treasurer

City of Zamboanga
AGENCY INFORMATION SHEET
NAME OF AGENCY
ADDRESS
OFFICE CODE
E-mail Address
Contact Number
:
:
:
:
:
Specimen Signatures
Head of Agency
Person in-charge
Position Title
Telephone Number
Fax Number
E-Mail Address
Ctiy Treasurer's Office

Cityhall, Valderosa st., Zamboanga City
100-1091
cto_zambocity@yahoo.com
991-2189
Soledad L. Li
City Treasurer
991-2189
991-2938
Assistant to the Head of Agency (if applicable)

Person in-charge
Reynaldo E. Aguidan
Position Title
Telephone Number
991-2189
Fax Number
E-Mail Address
Specimen Signature
Specimen Signature
Specimen Initial
Specimen Initial
Agency Remittance Advice

Person in-charge
Position Title
Telephone Number
Fax Number
E-Mail Address
Agency Remittance Advice

Person in-charge
Position Title
Telephone Number
Fax Number
E-Mail Address
Specimen Signature
Specimen Signature
Remittance Lists/Secondary Evidence(Payroll, Payslip, Subsidiary Ledger and Others)

Person in-charge
Person in-charge
Position Title
Position Title
Telephone Number
Telephone Number
Fax Number
Fax Number
E-Mail Address
E-Mail Address
Specimen Signature
Specimen Signature
Specimen Initial
Specimen Initial
Liason Officer 1
Person in-charge
Position Title
Telephone Number
Fax Number
E-Mail Address
Claribel C. Bais
Revenue Collection Clerk II
991-2189
Liason Officer 2
Person in-charge
Position Title
Telephone Number
Fax Number
E-Mail Address
Rosemarie V. Jacinto
Administrative Aide IV
991-2189
Specimen Signature
Specimen Signature
Specimen Initial
Specimen Initial
G. Agency Authorized Officer

Person in-charge
Position Title
Telephone Number
Fax Number
H. Alternate Authorized Officer

Person in-charge
Position Title
Telephone Number
Fax Number
E-Mail Address
E-Mail Address
Specimen Signature
Specimen Signature
Specimen Initial
Specimen Initial

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AAO Manual Annex C - Enrollement Form

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PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

(GOVERNMENT SERVICE INSURANCE SYSTEM)

Agency Authorized Officer Data Sheet

Approved by GSIS Department Manager

PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

Agency Authorized Officer Contact Details

Signatures of Requesting Agency Officers

SOLEDAD L. LI/CITY TREASURER

Approved by GSIS Department Manager

PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

Office Name OFFICE OF THE CITY TREASURER

Asst. City Treasurer

Approved by GSIS Department Manager

Initial & Date

PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

Office Name OFFICE OF THE CITY TREASURER

Asst. City Treasurer

Approved by GSIS Department Manager

Initial & Date

PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

Agency Authorized Officer Contact Details

Signatures of Requesting Agency Officers

Approved by GSIS Department Manager

Republic of the Philippines

Office of the City Treasurer

Ctiy Treasurer's Office

Assistant to the Head of Agency (if applicable)

Agency Remittance Advice

Agency Remittance Advice

Remittance Lists/Secondary Evidence(Payroll, Payslip, Subsidiary Ledger and Others)

G. Agency Authorized Officer

H. Alternate Authorized Officer

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