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Agency Name:

Agency BP Number:

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.

TRANSACTION
Member BP Number Last Name First Name Suffix MI Salary Effectivity Date Position Employment status CODE
2004125979 MAGSAEL HERMAFE GREY 24,224.00 FEBRUARY 16,2018 Teacher-III Permanent
2003735508 FUENTEBILLA ALFREDITH DOJOLES 24,224.00 MARCH 12,2018 Teacher-III Permanent

Note: No need to attach the Notice Of Salary Adjustment (NOSA) and Notice of Salary Increase (NOSI)

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