Agency Name: Agency BP Number:

FOR AGENCY REMITTANCE ADVICE

FORM A: List of employees with life and retirement premium remittance but without existing record in the GSIS Database.

Last Name ORENSE

First Name LOLITA

Suffix

Middle Name REMO

Mailing Address/Zip Code

Cellular Phone No.

Email Address

Sex

CS

Date of Birth

Place of Birth

Basic Montly Effectivity Date Salary

Position

If any or all of the employees listed above are new employees in that Agency, please provide the above information in the appropriate column.

FORM B: LIST OF TRANSFERRES

Member BP Number Last Name First Name Suffix MI Date of Transfer Salary Position Employment Status

If any or all of the employees listed above are transferees, please provide the information required in Form B below opposite their name.

FORM C: LIST OF EMPLOYEES WITH SALARY ADJUSTMENTS FOR CONFIRMATION AS TO CORRECT

AMOUNT OF SALARY AND EFFECTIVITY DATE TO BE SUPPLIED BELOW Member BP Number Last Name 40082601018 ORENSE 54040602995 BARIUAN 69111700931 MUECO 72072400543 ARIOLA 71010100750 ESMEDILLA 68041301272 ROBLES 71111800850 LAGMAY 50081802359 TEJANO 65112600536 DIMAYUGA 64040401910 GARCIA 71100100881 DIMAYUGA 68040800917 ABU 80060300082 GUEVARRA 54062701695 MANGUBAT 82111800282 BELLEZA LEYRAN 80112200723 ORENSE 2003456998 DEL ROSARIO 2003732610 ALDUEZA ****Nothing Follows*** First Name LOLITA CORAZON GREGORIO EDNA ANGELITA HELEN ROMANA GLENDA FELILIA LEAH RICHEL ARLENE SONIA DIONISIA OLIVER CARMEN NARLENE JANE NOVELYN EDHEN LUISA Suffix R. C. T. V. C. D. S. A. D. T. L. B. R. L. N. M. J. I. O. Salary 26,314.00 23,581.00 22,214.00 16,753.00 16,753.00 16,753.00 16,753.00 16,424.00 16,424.00 16,424.00 15,119.00 15,422.00 15,119.00 16,050.00 15,119.00 14,198.00 14,198.00 14,198.00 14,198.00 Effective Date 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 7/1/2009 Position Principal II MT I MT I T III T III T III T III T III T III T III T II T II T II T II T II TI TI TI TI Employment Status Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent Regular Permanent

FORM D: LIST OF EMPLOYEES WITH NO PREMIUM REMITTANCE FOR 2 CONSECUTIVE MONTHS

1 Reason 1 Remarks

Member BP Number

Last Name

First Name

Suffix

MI

Effectivity Date

1 Reason: Please specify whether transferred to other office/resigned/retired/deeased/dismissed/laid off/end of term/end of contract/dropped from the rolls/ suspended/on leave without pay, etc. 2 Remarks: in case transferred to other office, please indicate new office (if available)

Agency Name: Agency BP Number:

FOR AGENCY REMITTANCE ADVICE

FORM E: List of employees with changes/correction in their Personal Data.

Member BP Number

Last Name From To From

First Name To From

Suffix To From

Middle Name To

Mailing Address/Zip

From

To

Cellular Phone No. From To

Email Addr From

*For change of date of birth, please attach scanned copy of Original NSO authenticated Birth Certificate.

Address To

Date of Birth* From To

Place of Birth From To

Position/Title From To

Status of Employment

From

To