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BRANCH/OFFICE
Street Name
Subdivision
PCH-1
Barangay
DAMILAG
Municipality/City
MANOLO FORTICH
Pag-IBIG II
NAME OF MEMBERS First Name Name Extension (Jr., III, etc.) TRACY LYN
Modified Pag-IBIG II
Middle Name ACCOUNT NO. MONTHLY COMPENSATION
EMPLOYEE SHARE
JULY / 2013
CONTRIBUTIONS
EMPLOYER SHARE TOTAL
REMARKS
1210 7730 6163 1210 9268 4177 1210 3706 4269 1210 9263 5828
1210 7733 0166
ABRRE BUSANO CABALE CABRERA CATIG CEMPRON CURAY JOSE LARIZA MAGKILAT NESPEROS ROLOMA ROLOMA TORRES
PIQUERO CEPEDUSA ELLEVERA PLAGATA ACERO LOFRANCO APARECE HAWAN PALMES LAGAT RUSIA FELISILDA DUMPA VALMORIA
PATRICIA ROSENDA MA. CASSANDRA LUMEN MAYBELLE AMORLISA LOURVEL MAE AIZA JEFFREY MARIA THERESE ALLAN JENIE DOROTHY
6,000
6,000
100 100 100 100 100 100 100 100 100 100 100 100 100 100
100 100 100 100 100 100 100 100 100 100 100 100 100 100
200 200 200 200 200 200 200 200 200 200 200 200 200 200
4,000
6,000 7,500 5,500 6,000 6,000 6,000 4,500 4,300 6,000 6,000 5,000
1210 9257 2074 1210 9259 4199 1210 9283 1792 1210 9266 8690 1210 5178 2474 1210 9284 8029 1210 7713 2662 1210 9262 3451 1210 4479 0223
\\
14
14
1,400 1,400
1,400 1,400
2,800 2,800
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.
_________________________
DATE
DESIGNATION/POSITION
(Revised 03/2011)
1 2 3 4
5 6 7 8 9
The maximum Monthly Compensation to be used in computing the employee and employer contributions shall not be more than 5,000.00. A member may contribute more than what is required, however the employer shall only be mandated to contribute two percent (2%) of the monthly compensation of the member as counterpart contribution. In case the member increases his/her monthly membership contribution, the employer shall have the option to match said increase or to contribute only what is required. f. Membership contribution payments to be remitted should be equal to the total amount reflected in the MCRF. Check payments should be made payable to HDMF and shall be posted upon clearing. g. Employers with over remittance from previous payments shall be issued with a Notice of Overpayment and Credit Memo. For remittances previously made for employees for whom remittances should not have been made, the employer shall request a refund subject to the Funds verification and approval. The request shall be made not later than six (6) months from the time said remittance was made. h. Employers who shall remit on or before the due date as evidenced by the validated Membership Contribution Remittance Form (MCRF) or Pag-IBIG Fund Receipt shall be entitled to an incentive fee equivalent to 0.2% of the amount remitted provided he satisfy all the conditions required.
10 11
12-14
1 2 4 6
8 9 10
15
3 5 7 11
12 13 14
- Newly Hired - Leave Without Pay/AWOL - Resigned/Separated - Retired - Deceased - Others, please specify reason
L RS RT D O
16 17 18 19 20
18 16 17 19 20
Indicate the number of members listed in this page. Indicate the total number of members listed if this is the last page of the listing. Indicate the total amount due and employer contributions per page Indicate the grand total amount due and employer contributions if this is the last page Employer Certification - to be accomplished and duly signed by the Head of Office/Authorized Representative.