- G sIs Government Service Insurance System

Financial Center, Pasay City, Metro Manila 1308

Agency Authorized Officer (AAO) Commitment Form

I, Fofi\1-11e,f(.. C..·
()o(Z.T, 1, 0 (Name of MO),
]:;6 !1'< - t (Position Title), JL (Salary Grade) of
p,....,, A!I \JI\! (Name of Agency) understand that I have been
designated as Agency Authorized Officer of the t'A111 1A .i
(Name of Agency), and in so doing, I commit to act responsibly and prudently in
performing my functions.

As part of my responsibilities as an MO, I will:

1. Certify the loan applications of GSIS members under my operational

jurisdiction as to the following:

a. That the net take home pay of the member-borrower is sufficient to

cover the regular monthly amortization of the loan applied for and is
within the minimum net take home pay required by the General
Appropriations Act (GM);

b. That the member-borrower is in active service and not on leave of

absence without pay;

c. That the member-borrower has no pending administrative and/or

criminal charge against him/her (applicable under the Conso-Loan
Program and Regular Policy Loan);

2. Undertake the following actions:

a. That the monthly amortization shall be deducted from the member

borrower's monthly salary;

b. That in case the member-borrower is subsequently separated from the

service, the agency shall make the final payment to him or her only after
clearance is obtained from the GSIS; and

c. That the information supplied by the member-borrower is true and

correct based on the records of the agency.

3. Transmit electronically to the GSIS the membership updating request form/s

prepared by our Human Resources (HR) personnel. The forms must be

II P
 transmitted to the GSIS within the month the information (i.e., newly hired
employee, new salary, updated personal information, etc.) becomes
available.

4. Ensure that my agency is enrolled in the Electronic Billing and Collection

System (eBCS) of the GSIS.

5. Coordinate with the ERF Handlers on the following:

a. Timely deduction of the monthly amortization due on the loans certified

or approved;

b. Changes in the membership records submitted to GSIS are duly

reflected in the next generated remittance file; and

c. Reconciliation Billing Issues (RBIs) forwarded by the GSIS or the

generated eBCS exception reports are addressed and the appropriate
membership updating forms are prepared and transmitted to GSIS
before the following month's remittance.

6. Monitor feedback from the GSIS Membership Coordinator and to submit any
additional requirements promptly.

7. Transmit to the officer or employee concerned the circulars and/or

information dissemination materials, and requests for data or information
forwarded by the GSIS through the AAO module or my email address.

8. Attend trainings and re-trainings for AAOs.

Signed: Date:

Endorsed J,y: Date:

C\
&
c..
fir ('l.CI1,0\

f
r'.).
Nam d sfgn ture, Human Resources Officer

Note: All pages must be signed.

The Principal and Alternate AAO should sign two copies of this
Commitment Form, return one (1) copy to the GSIS and keep the other for
reference.

21
 PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN
(GOVERNMENT SERVICE INSURANCE SYSTEM)
Financial Center, Pasay City, Metro Manila 1308

AAO ELECTRONIC ONLINE SYSTEM FORM

,
Agency Authorized Officer Data Sheet U New D Renewal D Termination t,.d" Reactivation

Agency Name
PMW-<i' t.J.4'11t> 1-HCll\
Agency BP No
Io ooo q5 11I
Agency Address
t<. 11 P . PAnl\4M\) CklAA CC44, , ¼At'< I«.
- GSIS Old ID No.IBP No.
Last Name 1?or-11\..l;A oo
F irst Name Ol'(\1--1It,IL
Middle Name U.CMO
Salary Grade 1l
Agency Authorized Officer Contact Details
Mobile Number: f; 0 '2{. . \G\..!,
Office Number with Area Code
Email Address Oornll01C1011\..:,,k @ Dimc:4l . c,a,n
Agency Authorized Officer Mother's Maiden Name
Information Mother's Maiden Last Name C/'l&Afl
Mother's First Name 00\.,\r,.
Mother's Maiden Middle Name Ml A
Signatures of Requesting Agency
Officers
Agency
ovi,...... ,-,&{
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Authorized Officer:
- (}J
1,4,AOO r -1 -- oi - M- - '),0'}1.7. I Ty
( ) pe:
P ri ncipal
t1
Signature <Jver Pfinted Name Designation/Position Date Accomplished
I(..-r Alternate

lndorsing Offi er:

fl.but, 111,
O\ l".J • l"i;:o'!,C\ tJtJ... -1,,u, fW!U)
1'.'!Qov t! 8' '2:i.! L o10
Signatrover Printed Name Designation/Position Date Accomplished

Mobile No. Email

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
receives a request for termination.

Please Do Not Fill-Uo. For GSIS Use Onlv

Reviewed by GSIS Accounts Management Staff

Approved by GSIS Department Manager Date Accomplished

Action Taken Initial & Date

D Authorization Enabled D Authorization Disabled

Notes:
1. All boxes MUST be filled up (Type or Print) except signature/designation portion of AAOs
for