TMP-CH-124-17

ONEHUB eGOBYERNO COMPANY ENROLLMENT FORM

*PLEASE PRINT IN CAPITAL LETTERS

COMPANY/ ACCOUNT INFORMATION

COMPANY NAME TYPE OF COMPANY ACCOUNT NUMBER
ROICE'S GOLD ROOM CORPORATION Government ✖ Private Insurance 0 0 2 2 1 0 0 0 9 5 9 0
CURRENT OFFICE ADDRESS TIN (9 DIGITS)
112 SCOUT DELGADO COR TOMAS MORATO SACRED HEART QUEZON CITY 1103
No. Street Subdivision/ District / Town City/ Municipality Province Zip Code
CONTACT PERSON UNIT/ DEPARTMENT EMAIL ADDRESS PHONE NO. / FAX NO.
SHEILA MAE G. MORALES MANAGEMENT DEPARTMENT sheilamaemorales07@gmail.com 0285180178
PRODUCT / SERVICE AVAILMENT
PRODUCT / SERVICE REGISTERED ADDRESS
✖ SSS 112 SCOUT DELGADO COR TOMAS MORATO SACRED HEART QUEZON CITY
No. Street Subdivision/ District / Town City/ Municipality Province Zip Code
SSS NUMBER (10 DIGITS) SSS CONTRIBUTION LOCATOR CODE
0 3 9 5 9 0 0 3 1 0

✖ PAG-IBIG REGISTERED ADDRESS

112 SCOUT DELGADO COR TOMAS MORATO SACRED HEART QUEZON CITY
No. Street Subdivision/ District / Town City/ Municipality Province Zip Code
PAG-IBIG NUMBER (12 DIGITS) PAG-IBIG CODE
2 0 7 8 8
Bureau of Customs/ CDT FOR BOC: AAB REFERENCE NO. (16 DIGITS)

PHILHEALTH NUMBER (10-12 DIGITS) FOR PEZA: PAYOR'S CODE (4 DIGITS)

PHILHEALTH
PEZA

AUTHORITY TO DEBIT (IF FUNDING ACCOUNT IS DIFFERENT FROM THE ACCOUNT NUMBER STATED ABOVE)
FUNDING ACCOUNT NUMBER By signing below, I/ we authorize Union Bank of the Philippines to debit the account indicated for the purpose of online payments
to government agencies/ OneHub utilities selected above.

FUNDING ACCOUNT NAME

AUTHORIZED SIGNATORY OF THE FUNDING ACCOUNT AUTHORIZED SIGNATORY OF THE FUNDING ACCOUNT
Signature Over Printed Name / Date Signature Over Printed Name / Date

Please attach an extra sheet, if necessary. ENROLLMENT DETAILS

THE FOLLOWING USER/S ARE AUTHORIZED TO USE THE ABOVE FACILITY SUBJECT TO THE TERMS AND CONDITIONS OF THE SERVICE.
General Instructions
1 Please ensure that the required information is complete and accurate. The Bank shall deem the information on this form valid and enforceable.
2 Please indicate your company's Approval Policy. Include at least one Processor. For Single Approvals, at least one Approver is required. If no Approval Policy is indicated, the
default Approval Policy is SINGLE.
3 For authorized user's access, please choose whether the user is a Processer or Approver. The Processor uploads the payment and the Approver verifies / approves the
uploaded payment by the Processor.
4 The Transaction Amount Limit is only applicable to user/s with Approver access. If Approver has no transaction amount limit for approval, indicate "N L" (No Limit). The default
transaction limit is "No Limit".
5 Please use a unique email address per authorized user. User IDs shall be sent to the specified email address. The User IDs and passwords shall authorize the bank to accept
instructions from the user. It is the user’s responsibility to keep such information secure and confidential.

APPROVAL POLICY Single Dual

AUTHORIZED USER'S
MOBILE NUMBER ACCESS RIGHT
AUTHORIZED USER/S EMAIL ADDRESS WITH AUTO
TRANSACTION AMOUNT
EMAIL
(LAST/FIRST/MIDDLE) (COMPANY EMAIL) COUNTRY LIMIT
NUMBER ADVICE
CODE PROCESSOR APPROVER
(ex. 9171234567)
(ex. 63)

By signing below, I/ we confirm that I/ we have read, understood, and fully agree with the UnionBank OneHub Terms and Conditions, a copy of which has been provided to me/ us and
was made an integral part of this form.

AUTHORIZED BANK SIGNATORY OF THE COMPANY AUTHORIZED BANK SIGNATORY OF THE COMPANY
Signature over Printed Name / Date Signature over Printed Name / Date
FOR BANK'S USE ONLY
Relationship Manager Cash Solutions Manager

Relationship Group Region / Group

ENDORSED BY (Relationship/Business Manager) SIGNATURE VERIFIED BY (Branch Manager) REVIEWED BY (Cash Solutions Manager) PROCESSED BY (Systems Access Control)

RM's Signature over Printed Name/ Date Signature over Printed Name/ Date Signature over Printed Name/ Date Signature over Printed Name/ Date

Revised December 2017

 UnionBank OneHub
Terms & Conditions
This UnionBank OneHub Agreement for accessing your accounts via UnionBank OneHub explains the terms and conditions governing online services. The
terms “we”, “us”, “our”, “Bank” and “Services” refer to UnionBank OneHub. “You”, “Your” and “Client” refers to each signer on an account.

I. TRANSACTING USING YOUR BANK ACCOUNTS

A. To transact through UnionBank OneHub, you must have an eligible Bank account and an access ID.

II. DEFINITION OF ACCESS PARAMETERS

A. USER - shall refer to the person authorized to transact online payments on behalf of the enrolled Company
B. TRANSACTION AMOUNT LIMIT - shall refer to the authorized amount limit which can be paid by the specific user on a single transaction basis. The
transaction amount limit may vary depending on the policies of the Company per authorized user. You may choose to indicate “NO LIMIT” to mean that
the authorized user does not have any amount limits in effecting a payment to a merchant.

III. TERMS AND CONDITIONS

A. ACCESS ID. Each UnionBank OneHub Company Enrollment Form can consist of single or several enrollees. Business Enrollees: The primary enrollee
is the signatory or owner of the account. Access IDs will be assigned to each of the authorized representatives. Each access ID is dependent on the
parameters defined in the enrollment form.
B. ONLINE PASSWORD. An online password will be assigned to each access ID that will allow access to the specified Bank account online depending on
the parameters defined in the enrollment form. We are to act on instructions received under your access ID. For security purposes, it is recommended
that you memorize this online password and do not write it down.
C. FEES. We reserve the right to charge or change fees on the services rendered by the Bank and in our business judgment, to waive, reduce, or reverse
charges and fees as may be warranted.
D. NEW SERVICES AND CHANGES. The bank may, from time to time, introduce new or changes in its Services.
E. YOUR REPRESENTATION AND WARRANTY. It is absolutely necessary that you take adequate security and precautionary measures to ensure at all
times that the Services herein rendered by the Bank shall be furnished and disclosed only to your duly authorized representative. In the event that the
information falls in the hands of unauthorized persons for any reason whatsoever, including but not limited to wiretapping of communication lines
or erroneous connection by telecommunication switches, or errors in transmitted information due to faulty lines, and any and all forms of high technology
surveillance or fraud, you unconditionally and irrevocably agree and undertake to keep the Bank free and harmless at all times from any and all liability,
costs, damages, losses and causes of action arising from or in any way connected with the Services, including but not limited to, the effect of
the provisions of Republic Act No. 1405 (Law on Secrecy of Bank Deposits), as amended; applicable provisions of the General Banking Act and pertinent
laws prohibiting disclosure of information concerning your transaction or deposits with banks, and any and all pertinent laws or regulations related thereto
or the subject matter herein. Further, you unconditionally and irrevocably agree to be liable for all transactions consummated from your account provided
that the parameters defined in the enrollment form are followed. This agreement also serves as your blanket authorization to the Bank to effect the debit
from your account for all transactions consummated provided that the parameters defined in the enrollment form are followed.
F. OUR LIABILITY. UnionBank shall not be liable for any loss or damage of any nature in connection with the implementation of online transactions in the
following instances:
1. Disruption, failure or delay relating to or in connection with the Services which are due to circumstances beyond the control of the
Bank, unforeseen events, fortuitous events such as but not limited to prolonged power outages, breakdown in computers and
communication facilities, typhoons, floods, public disturbances and calamities and other similar or related cases;
2. Loss or damage suffered by the Client arising out of any fraudulent access or utilization of the Services due to theft or unauthorized disclosure of
access ID's, passwords or violation of other security measures used for the Online System with or without the participation of the clients;
3. Inaccurate, incomplete or delayed information is received by the Client due to disruption or failure of any communication facilities used for the
System;
4. Any indirect, incidental or consequential loss, loss of profit or damage suffered by the Client by reason of its use or failure or inability to use the
Services provided under this Agreement and other applicable terms and conditions covering our e-mail, telephone banking and ATM services.
G. OTHERS. Should the Bank become involved in any litigation which may have relation with this Agreement, or with any of the rights, powers
and remedies hereunder, all fees and expenses incurred by the BANK in such a litigation, including a reasonable amount for the attorney's fees which amount
is hereby agreed to be at the rate of 10% of the sum sought or P10,000.00, whichever is higher, shall be borne by the Client. This Agreement shall be
governed by and construed in accordance with the laws of the Philippines. It shall be understood that access to and use of the System shall be subject to
applicable requirements and procedures of government telecommunications or other regulatory authorities and those prescribed by law. The venue of all
legal actions or proceedings arising out of or in connection with this Contract shall be brought in the proper courts of PASIG CITY.

IV. QUESTIONS OR ERROR CORRECTION ON ONLINE BANKING TRANSACTIONS

In case of questions or errors about the Services, you may do any of the following:
A. Send an email to our UnionBank Corporate Customer Care at union3c@unionbankph.com.
B. Call our Union Corporate Customer Care @ 667-2-668 . Our Union Corporate Customer Care Officers are available from Monday to
Friday during office hours.
C. Write to Union Corporate Customer Care, UnionBank of the Philippines, UnionBank Plaza, Meralco Ave. cor. Onyx & Sapphire Roads, Ortigas
Center, Pasig City.

If you have complaints or concerns on an error encountered for a particular transaction, we must hear from you not later than sixty (60) days after
the transaction took place. If you notify us verbally, we may require that you send us your complaint or question in writing within 24 hours.

In relating your complaint, kindly indicate:

A. Your name and the access ID;
B. The error you have encountered.

VI. CHANGES IN COMPANY AND USER INFORMATION

A. For changes in the Company/ Account information, please accomplish the OneHub eGobyerno Company Information Maintenance Form.
B. For changes in the User's details, please accomplish the User Maintenance Form.

VI. PROTECTING YOUR ACCOUNT

Your role is extremely important in the prevention of any wrongful use of your account. The password that is used to access our Services should be kept
confidential. If you believe that your access ID has been wrongfully used or your online password may have been lost, stolen, compromised or that someone
has used it without your permission, call our Corporate Customer Care immediately.

CONFORME: COMPANY NAME:

AUTHORIZED BANK SIGNATORY OF THE COMPANY AUTHORIZED BANK SIGNATORY OF THE COMPANY
Signature over Printed Name / Date Signature over Printed Name / Date

SIGNATURE VERIFIED BY:

Signature over Printed Name / Date

 ONEHUB eGOBYERNO COMPANY ENROLLMENT FORM
Reference for SSS and PAG-IBIG codes
The locator branch code facilitates the posting of contributions and loans to your respective branch office. The use of incorrect locator branch code will
result in non-posting of your contributions. It is highly recommended that you obtain the correct locator branch code from your respective government
agency branch office. UnionBank shall not be liable for any loss or damage of any nature in connection with our dependence on the locator branch
codes provided by your company in the OneHub eGobyerno Company Enrollment Form.

SSS CONTRIBUTION LOCATOR CODES

REGION I REGION III REGION V REGION VIII
A0 BAGUIO C0 MAKATI 1 E0 NAGA H0 CAGAYAN DE ORO
A1 CAUAYAN C1 CUBAO E1 LEGASPI H1 BUTUAN
A2 LA UNION C2 MANILA E2 DAET H2 ILIGAN
A3 LAOAG C3 PASIG 1 E3 SORSOGON H3 TANDAG
A4 BANGUED C4 KALOOKAN E4 GOA H4 SURIGAO
A5 VIGAN C5 ALABANG E5 MASBATE H6 VALENCIA
A6 TUGUEGARAO C6 DILIMAN E6 VIRAC H7 GINGOOG
A7 SOLANO C7 C7 MARIKINA E7 IRIGA H8 OZAMIS
A9 BONTOC C8 NOVALICHES E8 TABACO H9 OROQUIETA
AB SANTIAGO C9 BINONDO HC CAMIGUIN
REGION VI
CA MALOLOS
REGION II F0 CEBU
CB PASAY-ROXAS BLVD REGION IX
B0 TARLAC F1 TACLOBAN
CC BACOOR I0 DAVAO
B1 PAMPANGA F2 TAGBILARAN
CE BALIUAG I1 GENERAL SANTOS
B2 DAGUPAN F3 LAPU-LAPU
CF ANTIPOLO I2 KORONADAL
B3 OLONGAPO F4 ORMOC
CG STA MARIA I3 TACURONG
B4 CABANATUAN F5 CATBALOGAN
CH MEYCAUAYAN I4 DIGOS
B5 BALANGA F6 MAASIN
CI VALENZUELA I5 TAGUM
B6 URDANETA FA TOLEDO
CJ CAINTA I6 MATI
B7 ALAMINOS FC CALBAYOG
ANGELES CL LAS PINAS I7 BISLIG
B8 FE MANDAUE
B9 CAMILING CM TAGUIG I8 KIDAPAWAN
BA BALER CO PARANAQUE REGION VII I9 COTABATO
BC MARIVELES CP PATEROS G0 BACOLOD IC TORIL
BE IBA CS CQ POEA G1 ILOILO
CR EPZA, ROSARIO G2 KALIBO REGION X
REGION IV CS TAGAYTAY G3 ROXAS J0 ZAMBOANGA
D0 SAN PABLO CT MANDALUYONG G4 ANTIQUE J1 PAGADIAN
D1 CALAMBA CU MALABON G5 DUMAGUETE J2 DIPOLOG
D2 STA. CRUZ CV MAKATI 2 G6 SAN CARLOS J3 JOLO

D3 LUCENA CX SF DEL MONTE G7 KABANKALAN J4 BASILAN

CY WELCOME G8 BAIS J5 IPIL
D4 BATANGAS
CZ SAN JUAN GC VICTORIAS
D5 BOAC
M1 CARMONA GD SAGAY
D6 SAN JOSE
M2 MAKATI 3 GE BAGO
D7 CALAPAN M3 PASIG 2
D8 ROMBLON M4 COMMONWEALTH
D9 PALAWAN M5 SAN MATEO
DA LIPA M6 PASAY-TAFT
MP NAVOTAS
DE BINAN
MY RECTO

PAG-IBIG CODES (EPCF)

01 MAKATI I 28 LA UNION 58 ILOILO
02 MAKATI II 29 BAGUIO 59 BACOLOD
10 MAKATI III 30 DAGUPAN 64 CEBU SOUTH
03 IMUS 34 TUGUEGARAO 67 CEBU NORTH
04 PASAY 40 SAN FERNANDO 70 TACLOBAN
05 INTRAMUROS 41 MALOLOS 76 ZAMBOANGA
06 CALOOCAN 42 DINALUPIHAN 77 PAGADIAN
07 KAMIAS 46 LUCENA 82 CAGAYAN DE ORO
CUBAO CALAMBA 83 BUTUAN
08 47
BATANGAS 88 DAVAO
09 ORTIGAS 49
89 GENERAL SANTOS
INTERNATIONAL OPERATIONS 52 LEGAZPI
11 90 TAGUM
GROUP 53 NAGA
17 ANTIPOLO 94 COTABATO
54 CALAPAN
95 ILIGAN