HQP-TMF-191

(V03, 07/2018)

PAYMENT INSTRUCTION FORM (PIF)

BALANGA
______________________________
Pag-IBIG Servicing Branch

Employer ID Number : 206216750002

Payment Instruction Date : July 08, 2021
7211 89EE 8B8A
Payment Instruction Number

EMPLOYER/BUSINESS NAME : CUPANG WEST MULTI PURPOSE COOPERATIVE

ADDRESS AND CONTACT DETAILS

Unit/Room No., Floor Building Name Lot No., Block No. AREA CODE TELEPHONE NUMBER
Business (Direct Line)
Phase No. House No. Street Name
MASIKAP Business (Trunk Line) Local
Subdivision Barangay Municipality
Cell Phone
CUPANG WEST BALANGA CITY
09282168527
Province Region Zip Code
Business Email Address
BATAAN REGION 3 (CENTRAL LUZON) 2100 cupangwest_mpc@yahoo.com.ph

PERIOD COVERED
TYPE OF PAYMENT AMOUNT DUE CLIENT PRINT VALIDATION
From To
MEMBER SAVINGS 06 - 2021 06 - 2021 1,200.00

TOTAL AMOUNT 1,200.00

Prepared by: Date:

______________________________ 07/08/2021
____________
ALPHA
Name AGUSTIN
and GIPAYA
Designation
BOOKKEEPER

REMINDERS:
07/08/2021
1. This form is valid from ______________ 08/06/2021
to ______________. If payment to be made is beyond the reflected validity period, this form will not be accepted
by any accredited collecting partner/s.
2. Please remit MS/pay loan obligation on or before the due date to avoid incurring penalties.

Employer ID Number 206216750002

PIN: 721189EE8B8A Total Amount Due Php 1,200.00

TO BE FILLED OUT BY THE PAYOR
CUPANG WEST MULTI PURPOSE COOPERATIVE
Cash Payment
MASIKAP, CUPANG WEST, BALANGA CITY, BATAAN, 2100
Check Payment
Check No.
Bank/Branch