PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

(GOVERNMENT SERVICE INSURANCE SYSTEM)

Financial Center, Pasay City, Metro Manila 1308

AAO ELECTRONIC ONLINE SYSTEM FORM

Agency Authorized Officer Data Sheet New Renewal Termination Reactivation

Agency Name ILIGAN CITY NATIONAL HIGH SCHOOL

Agency BP No 1000003011

Agency Address GEN. WOOD ST., MAHAYAHAY, ILIGAN CITY

GSIS Old ID No./BP No. 2003987497

Last Name MENDIJA
First Name LEAH
Middle Name CAMIGUIN
Salary Grade 15
Agency Authorized Officer Contact Details
Mobile Number: 09177009015
Office Number with Area Code (063) 228-3019
Email Address leahcmendija@gmail.com
Agency Authorized Officer Mother’s Maiden Name Information
Mother’s Maiden Last Name SATUR
Mother’s First Name FELIXBERTA
Mother’s Maiden Middle Name TINOY
Signatures of Requesting Agency Officers
Agency Authorized Officer: Type:

LEAH C. MENDIJA Admin. Office IV September 03, 2018 ( ) Principal

Signature over Printed Name Designation/Position Date Accomplished
(x) Alternate

Indorsing Officer

REX L. RAZO Sec. School Principal III September 03, 2018

Signature over Printed Name Designation/Position Date Accomplished

Mobile No. 09171500333 Email: icnhs_principal@yahoo.com

We understand that by affixing our signatures on the above, authorization when granted, is specific
to the office specified in this application form. Moreover, it will be disabled after GSIS receives a
request for termination.
Please Do Not Fill-Up. For GSIS Use Only
Reviewed by GSIS Accounts Management Staff

Approved by GSIS Department Manager Date Accomplished

Action Taken Initial & Date

Authorization Enabled Authorization Disabled

Notes:
1. All boxes MUST be filled up (Type or Print) except signature/designation portion of AAOs for
TERMINATION.
2. Authorizations are valid until request for termination is received by the GSIS.