HQP-PFF-053

MEMBERSHIP SAVINGS Pag-IBIG EMPLOYER'S ID NUMBER

REMITTANCE FORM ( MSRF ) 2090-2034-0001

EMPLOYER/BUSINESS NAME
FST BUILDERS
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No Street Name
22 BMA AVE.
Subdivision Barangay Municipality/City Province/State/Country (if abroad) Zip Code
TATALON QUEZON CITY 1113
MEMBERSHIP CONTRIBUTIONS
MEMBERSHIP NAME OF EMPLOYEES
Pag-IBIG
PROGRAM PERIOD
MID NO./RTN ACCOUNT NO, NAME EXT. Middle Name MONTHLY EE ER REMARKS
Last Name First Name COVERED
COMPENSATION
(JR., III, ETC) SHARE TOTAL
SHARE

1212-5455-2668 ESCAT JUANITO CORPUZ Aug-19 100 100 200

1212-4706-4050 BAUYAN FELIX JR MECOLLAR Aug-19 100 100 200
*** NOTHING FOLLOWS***

TOTAL FOR THIS PAGE 200 200 400.00

GRAND TOTAL (if last page) 200 200 400.00
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.

MR. FLORENTINO S. TAGANGUIN JR. OWNER

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE DESIGNATION/POSITION DATE
(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE (REVISED 7/2012)