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E SRS

This document is an employer enrollment form for the Pag-IBIG Fund electronic salary reporting system (eSRS). It requests information such as the employer's 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. The form is signed by an authorized signatory of the employer.

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Laurence Rabuya
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353 views

E SRS

This document is an employer enrollment form for the Pag-IBIG Fund electronic salary reporting system (eSRS). It requests information such as the employer's 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. The form is signed by an authorized signatory of the employer.

Uploaded by

Laurence Rabuya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HQP-TMF-190

(V04, 07/2018)

eSRS EMPLOYER ENROLLMENT FORM

Employer ID Number :
Employer/Business Name :
Pag-IBIG Servicing Branch :
Employer Type (i.e., 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

Region 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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