USER ENROLMENT FORM v2

* all fields are required

* Do not directly edit here. Download this sheet first, fill-up necessary fields, and submit to your BTr field office

USER INFORMATION
Email Address ya_mey_lan@yahoo.com xsoliven@gmail.com
First Name MELANIE AURIE e.g.: Ian
Middle Name RANGAYA e.g.: Santos
Last Name AREVALO e.g.: Soliven
Position Title DISBURSING OFFICER I e.g.: Computer Programmer II

ACCESS RIGHTS
Usergroup LGU/NGA/GOCC/GFI if LGU/NGA/GOCC/GFI: NGA
System Role Encoder

ORGANIZATION
Department DEPARTMENT OF EDUCATION e.g.: Department of Transportation
Agency (Whole Name) (Acronym) QUIPAYO NATIONAL HIGH SCHOOL QNHS e.g.: Land Transportation Office (LTO)
Operating Unit Camarines Sur e.g. : Manila Office

LOCATION
Region R5 e.g. : NCR
Province/District CAMARINES SUR/ 3RD DISTRICT e.g. : District 1
City/Municipality QUIPAYO CALABANGA e.g. : Manila

Signatories

Signature of the User

Fullname of User MELANIE AURIE R. AREVALO
Position of User DISBURSING OFFICER I
Date Filed (mm/dd/yyyy) September 11, 2021

Signature of Head of Agency

Fullname of Head of Agency NATIVIDAD C. DE LEON
Designation of Head of Agency PRINCIPAL I

this part is to be filled up by the BTr admin

generated username CAMARINESSUR/3 CAMARINESSUR/3 camarinessur/3rddistrict

date created (mm/dd/yyyy) AREVALO AREVALO arevalo

Signature of User Admin

Fullname of User Admin
Designated BTr office R5 - CAMARINES SUR/ 3RD DISTRICT

- if you are applying as NGA/LGU/GOCC/GFI user, please submit the accomplished form to your designated BTr field office.
 USER ENROLMENT FORM v1
* all fields are required
* Do not directly edit here. Download this sheet first, fill-up necessary fields, and submit to your BTr field office

USER INFORMATION
Email Address xsoliven@gmail.com xsoliven@gmail.com
First Name Ian Hero e.g.: Ian
Middle Name Santos e.g.: Santos
Last Name Soliven e.g.: Soliven
Position Title Computer Programmer II e.g.: Computer Programmer II

ACCESS RIGHTS
Usergroup LGU/NGA/GOCC/GFI if LGU/NGA/GOCC/GFI: NGA
System Role Admin

ORGANIZATION
Department Department of Transportation e.g.: Department of Transportation
Agency (Whole Name) (Acronym) Land Tranportation Office LTO e.g.: Land Transportation Office (LTO)
Operating Unit Manila Office e.g. : Manila Office

LOCATION
Region NCR e.g. : NCR
Province/District District 1 e.g. : District 1
City/Municipality Manila e.g. : Manila

Signatories

Signature of the User (affix signature here)

Fullname of User Ian Hero Santos Soliven
Position of User Computer Programmer II
Date Filed (mm/dd/yyyy) December 26, 2021

Signature of Head of Agency (affix signature here)

Fullname of Head of Agency Edgar Galvante
Designation of Head of Agency Chief

this part is for the BTr system admin

generated username issoliven_ncr_district1_nga_ad District1 District1 district1

date created (mm/dd/yyyy) Soliven Soliven soliven

Signature of User Admin

Fullname of User Admin
Designated BTr office NCR - District 1

- if you are applying as BTR admin, please submit the accomplished form to issoliven@treasury.gov.ph
- if you are applying as NGA/LGU/GOCC/GFI user, please submit the accomplished form to your designated BTr field office.