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Esrs Employer Enrollment Form: Employer ID Number Employer Name Pag-IBIG Servicing Branch Employer Type

This document is an employer enrollment form for the Pag-IBIG Fund eSRS system. It requests information such as the employer ID number, name, address, contact details, and authorized user details. The employer certifies that the information provided is true and correct, and consents to disapproval or cancellation of enrollment if falsification is found from an authorized user. The form also has a section for Pag-IBIG Fund internal use and approval.

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Jo Louise
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2K views

Esrs Employer Enrollment Form: Employer ID Number Employer Name Pag-IBIG Servicing Branch Employer Type

This document is an employer enrollment form for the Pag-IBIG Fund eSRS system. It requests information such as the employer ID number, name, address, contact details, and authorized user details. The employer certifies that the information provided is true and correct, and consents to disapproval or cancellation of enrollment if falsification is found from an authorized user. The form also has a section for Pag-IBIG Fund internal use and approval.

Uploaded by

Jo Louise
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HQP-ITF-033

(V03, 05/2017)

eSRS EMPLOYER ENROLLMENT FORM

Employer ID Number :
Employer Name :
Pag-IBIG Servicing Branch :
Employer Type (e.g, Private or Government) :

ADDRESS AND CONTACT DETAILS


Unit/Room No., Floor Building Name AREA CODE TELEPHONE NUMBER
Business (Direct Line)
Lot No., Block No. Phase No. House No. Street Name

Business (Trunk Line) Local


Subdivision Barangay

Cell Phone
Municipality/City

Province Zip Code Business Email Address

AUTHORIZED USER DETAILS


Pag-IBIG MID Number : User Name :
Name : Email Address :
Designation : Cell Phone Number :

EMPLOYER’S CERTIFICATION

We certify that the information herein stated is true and correct; that we shall be responsible for all the information
provided by our Authorized User/s to Pag-IBIG Fund; that we consent to the disapproval or cancellation of our
enrolment, and/or termination of our access to the facility in case of falsification, misrepresentation or any similar acts
committed by our Authorized User/s.

____________________________ ______________________________ _______________


Authorized Signatory Designation Date
(Signature Over Printed Name)

FOR Pag-IBIG Fund USE ONLY

Approved by:

____________________________ ______________________________ _______________


Authorized Signatory Position/Designation Date
(Signature Over Printed Name)

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