HQP-PFF-053

MEMBER'S CONTRIBUTION Pag-IBIG EMPLOYER'S ID NUMBER

REMITTANCE FORM ( MCRF ) 20576415000

EMPLOYER/BUSINESS NAME
TANGCA CONSTRUCTION CORPORATION
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name
64 RODRIGUEZ STREET
Subdivision Barangay Municipality/City Province/State/Country (if abroad) Zip Code

JORDAN VALLEY BAESA QUEZON CITY 1106

ACCOUNT MEMBERSHIP CONTRIBUTIONS
MEMBERSHIP NAME OF EMPLOYEES MONTHLY
NO,
PROGRAM COMPENSATION
Pag-IBIG MID NO./RTN Last Name First Name NAME EXT. Middle Name MIDNAME PERIOD COVERED EE ER TOTAL REMARKS

(JR., III, ETC) SHARE

SHARE

0003-64774372 F1 TANGCA FLORENTINO JR MONTEMAYOR MARCH 2020 50,000.00 2,000.00 100.00 2,100.00
1211-64774372 F1 TANGCA MINERVA FAUSTINO MARCH 2020 50,000.00 2,000.00 100.00 2,100.00
1210-34145019 F1 TANGCA MARY ANN FAUSTINO MARCH 2020 30,000.00 2,000.00 100.00 2,100.00
1212-31260014 F1 TANGCA LOUIE ANTHONY FAUSTINO MARCH 2020 30,000.00 2,000.00 100.00 2,100.00
1212-31088953 F1 TEJERO JUNREY CABANES MARCH 2020 15,360.00 100.00 100.00 200.00

TOTAL FOR THIS PAGE 8,100.00 500.00 8,600.00

GRAND TOTAL (if last page) 8,100.00 500.00 8,600.00
EMPLOYER CERTIFICATION

I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best of my knowledge and belief. I further
certify that my signature appearing herein is genuine and authentic.

MINERVA F. TANGCA VICE PRESIDENT June 18, 2020

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE DESIGNATION/POSITION
(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE (REVISED 7/2012)