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 doloresprincipe14@gmail.com xsoliven@gmail.com
First Name JESSIE e.g.: Ian
Middle Name UNTIVEROS e.g.: Santos
Last Name JUSI e.g.: Soliven
Position Title BARANGAY CAPTAIN e.g.: Computer Programmer II

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

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

LOCATION
Region R4A e.g. : NCR
Province/District BATANGAS e.g. : District 1
City/Municipality SAN PASCUAL e.g. : Manila

Signatories

Signature of the User

Fullname of User JESSIE U. JUSI
Position of User Barangay Captain
Date Filed (mm/dd/yyyy) August 7, 2023

Signature of Head of Agency

Fullname of Head of Agency ANTONIO A. DIMAYUGA
Designation of Head of Agency Municipal Mayor

this part is to be filled up by the BTr admin

generated username BATANGAS BATANGAS batangas

date created (mm/dd/yyyy) JUSI JUSI jusi

Signature of User Admin

Fullname of User Admin
Designated BTr office R4A - BATANGAS

- 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) November 12, 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.