HQP-PFF-053

Pag-IBIG EMPLOYER’S ID NUMBER

MEMBERSHIP SAVINGS
205403700004
REMITTANCE FORM (MSRF)
NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.
EMPLOYER/BUSINESS NAME
IDEAS M SHOPPE, INC.
EMPLOYER/BUSINESS ADDRESS

Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name

UNIT 502 GEMPC BLDG. #132 TIMOG AVENUE

Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code

SACRED HEART QUEZON CITY METRO MANILA 1103

NAME OF MEMBERS MEMBERSHIP SAVINGS
Pag-IBIG ACCOUNT MEMBERSHIP Last Name First Name Name Extension PERIOD MONTHLY
Middle Name REMARKS

MID NO. NO. PROGRAM COVERED COMPENSATION

(Jr., III, etc.) EE ER
TOTAL
SHARE SHARE

102002250066 MACAPINLAC MA. CHARISSE GONZALEZ oct 100.00 100.00 200.00

121024533160 PICAZO DANIELA ALANA MADRONAL 2019 100.00 100.00 200.00

102002250389 ONG JEREMIE ROSALIE PEREZ 100.00 100.00 200.00
121028732096 REYNALDO ELIZABETH TAYO 100.00 100.00 200.00

TOTAL FOR THIS PAGE

GRAND TOTAL (if last page)

400 400 600.00
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.
MARIA CHARISSE ASUNCION MACAPINLAC PRESIDENT

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE DESIGNATION/POSITION DATE

(Signature Over Printed Name)
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
(V03, 10/2016)