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 barangaycacandongan@gmail.com
First Name ROLANDO
Middle Name LUCENA
Last Name DE GUZMAN
Position Title Punong Barangay

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

ORGANIZATION
Department Barangay Government of Cacandongan
Agency (Whole Name) (Acronym) Office of the Punong Barangay
Operating Unit Barangay Cacandongan, Bautista, Pangasinan

LOCATION
Region R1
Province/District Pangasinan
City/Municipality Bautista

Signatories

Signature of the User

Fullname of User ROLANDO L. DE GUZMAN
Position of User Punong Barangay
Date Filed (mm/dd/yyyy) May 22, 2023

Signature of Head of Agency

Fullname of Head of Agency ROLANDO L. DE GUZMAN
Designation of Head of Agency Punong Barangay

this part is to be filled up by the BTr admin

generated username
date created (mm/dd/yyyy)

Signature of User Admin

Fullname of User Admin
Designated BTr office R1 - Pangasinan

- 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) August 23, 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.