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Ebcs Enrollment Form

This document is an enrollment form for the eBCS system. It collects contact and identification information for a remitting agency officer or finance officer, including their name, office details, phone numbers, email address and mother's maiden name. The form requires signatures from the requesting officer, an indorsing officer, and GSIS staff to approve and enable the authorization. Authorizations will be disabled once a termination request is received by GSIS.

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Zandie Garcia
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2K views1 page

Ebcs Enrollment Form

This document is an enrollment form for the eBCS system. It collects contact and identification information for a remitting agency officer or finance officer, including their name, office details, phone numbers, email address and mother's maiden name. The form requires signatures from the requesting officer, an indorsing officer, and GSIS staff to approve and enable the authorization. Authorizations will be disabled once a termination request is received by GSIS.

Uploaded by

Zandie Garcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

eBCS ENROLLMENT FORM

Remitting Agency Officer/ Finance Office Data Sheet New Termination


Office Name

Agency BP No

Office Address

GSIS Old ID No./BP No.


Last Name
First Name
Middle Name
Remitting Agency Officer/Finance Officer Contact Details
Cell Phone Number:
Office Telfax1 Number
with Area Code
Office Telfax2 Number
with Area Code
Email Address
Remitting Agency Officer/Finance Officer Mothers Maiden Name Information
Mothers Maiden Last Name
Mothers First Name
Mothers Maiden Middle Name
Signatures of Requesting Agency Officers
Remitting Agency Officer/Finance Officer:

_________________________ ________________ ________________


Signature over Printed Name Designation/Position Date Accomplished
Indorsing Officer:

________________________ _____________________
Signature over Printed Name Designation/Position
Email Address: Contact Number/s: ________________
________________________ _____________________ Date Accomplished

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 disabled after GSIS received
request for termination.
Please Do Not Fill-Up. For GSIS Use Only
Reviewed by GSIS Accounts Management Staff

Approved by GSIS Department Manager/Branch Manager Date Accomplished

Action Taken Initial & Date

Authorization Enabled Authorization Disabled

Notes:
1. All boxes MUST be filled up (Type or Print) except signature/designation portion of Remitting Agency
Officer/Finance Officer for TERMINATION
2. Authorizations are valid until request for termination is received by the GSIS

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