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 celyalba@ymail.com
First Name Medel
Middle Name Dalisay
Last Name Medrano
Position Title Barangay Captain

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

ORGANIZATION
Department Barangay Bayanan San Pascual Batangas
Agency (Whole Name) (Acronym) Brgy Bayanan BBSPB
Operating Unit San Pascual Batangas

LOCATION
Region R4A
Province/District Batangas
City/Municipality San Pascual

Signatories

Signature of the User

Fullname of User Medel D. Medrano
Position of User Barangay Captain
Date Filed (mm/dd/yyyy)

Signature of Head of Agency

Fullname of Head of Agency Medel D. Medrano
Designation of Head of Agency Barangay Captain

this part is to be filled up by the BTr admin

generated username mdmedrano_r4a_batangas_lgu_ad

date created (mm/dd/yyyy) March 27, 2023

Signature of User Admin

Fullname of User Admin March 27, 2023
Designated BTr office R4A - Batangas

- if you are from BTr and applying as user 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.
 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) March 27, 2023

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.