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HQP-PFF-053

MEMBERSHIP SAVINGS
Pag-IBIG EMPLOYER'S ID NUMBER

REMITTANCE FORM (MSRF)


NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.
EMPLOYER/BUSINESS NAME
WHILLMZ TRADING
EMPLOYER BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No., House No. Street Name
JUPITER STREET
Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
NEW CABALAN OLONGAPO ZAMBALES 2200
NAME OF MEMBERS MEMBERSHIP SAVINGS
Pag-IBIG MID MEMBERSHIP PERIOD MONTHLY
ACCOUNT NO.
PROGRAM
REMARKS
No./RTN Last Name First Name
Name Ext.
Middle Name COVERED COMPENSATION EE SHARE ER SHARE TOTAL
(Jr., III, etc)

121124823298 MENDOZA WILLMA GUEVARRA JANUARY 2019 100.00 100.00 200.00


121124823298 MENDOZA WILLMA GUEVARRA FEBRUARY 2019 100.00 100.00 200.00
121124823298 MENDOZA WILLMA GUEVARRA MARCH 2019 100.00 100.00 200.00

TOTAL FOR THIS PAGE 300.00 300.00 PHP 600.00

GRAND TOTAL (if last page)

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.

HEAD OF OFFICE OR AUTHORIZED REPRESENTATITVE DESIGNATION/POSITION DATE


(Signature Over Printed Name)