MEMBER’S CONTRIBUTION REMITTANCE FO

NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.

FPF060
Pag-IBIG EMPLOYER’S ID NUMBER

EMPLOYER/BUSINESS NAME

EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No.

Street Name Subdivision Barangay Municipality/City Pr

MEMBERSHIP PROGRAM
 Pag-IBIG I  Pag-IBIG II  Modified Pag-IBIG II
NAME OF MEMBERS
Last Name First Name Name Extension Middle Name
Pag-IBIG MID No. (Jr., III, etc.)
No. of Employees Total no. of Employees/
Members if last page

Members on this page

EMPLOYER CERTIFIC
I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE

THIS FORM MAY BE REPRODUCED.

(Revised 03/2011)
ITTANCE FORM (MCRF)

BRANCH/OFFICE

TYPE OF EMPLOYER
e No. House No.  Private  Household
 Government

Province/State/Country (if abroad) ZIP Code

PERIOD COVERED (month/year)

CONTRIBUTIONS
MONTHLY
ACCOUNT NO. EMPLOYEE EMPLOYER TOTAL
COMPENSATION
SHARE SHARE
oyees/ TOTAL FOR THIS PAGE
age

GRAND TOTAL (if last page)

EMPLOYER CERTIFICATION
and correct to the best of my knowledge and belief. I further certify that my signature appearing herein is genuine and authentic.

DESIGNATION/POSITION DATE

ORM MAY BE REPRODUCED. NOT FOR SALE.

REMARKS
in is genuine and authentic.