USER ENROLMENT FORM v1

* all fields are required

*Download this sheet first, fill-up necessary fields, and submit to your BTr field office. Do not delete generated username.

USER INFORMATION
Email Address rrcamontoy@gmail.com
First Name ROSELYN
Middle Name RIVERA
Last Name CAMONTOY
Position Title ADMIN.AIDE I/DISBURSING OFFICER-DESIGNATE

ACCESS RIGHTS
Usergroup LGU/NGA/GOCC/GFI if LGU/NGA/GOCC/GFI: LGU
System Role Admin

ORGANIZATION
Department MUNICIPAL TREASURER'S OFFICE
Agency (Whole Name) (Acronym) LOCAL GOVERNMENT UNIT OF TOLOSA LGU
Operating Unit LGU TOLOSA, LEYTE

LOCATION
Region R8
Province/District LEYTE
City/Municipality TOLOSA

Signatories

Signature of the User

Fullname of User ROSELYN RIVERA CAMONTOY
Position of User ADMIN.AIDE I/DISBURSING OFFICER-DESIGNATE
Date Filed (mm/dd/yyyy) January 7, 2022

Signature of Head of Agency

Fullname of Head of Agency MARIA OFELIA O. ALCANTARA, MD, MPH
Designation of Head of Agency MUNICIPAL MAYOR

this part is for the BTr system admin

generated username rrcamontoy_r8_leyte_lgu_ad
date created (mm/dd/yyyy)

Signature of User Admin

Fullname of User Admin
Designated BTr office R8 - LEYTE
 USER ENROLMENT FORM v1
* all fields are required
* Download this sheet first, fill-up necessary fields, and submit to your BTr field office

USER INFORMATION
Email Address xsoliven@gmail.com xsoliven@gmail.com
First Name IAN HERO e.g.: Ian
Middle Name SANTOS e.g.: Santos
Last Name SOLIVEN e.g.: Soliven
Position Title BARANGAY CHAIRMAN e.g.: Brgy. Chairman

ACCESS RIGHTS
Usergroup LGU/NGA/GOCC/GFI if LGU/NGA/GOCC/GFI: LGU
System Role Admin

ORGANIZATION
Department (BLANK) LEAVE IT BLANK
Agency (Whole Name) (Acronym) BARANGAY 14, TACLOBAN CITY 14 e.g.: Barangay 14, Tacloban City 14
Operating Unit BRGY. 14 e.g. : Brgy. 14

LOCATION
Region R8 e.g. : R8
Province/District Leyte e.g. : Leyte or Biliran
City/Municipality Tacloban City e.g. : Tacloban City

Signatories

Signature of the User (affix signature here)

Fullname of User IAN HERO SANTOS SOLIVEN
Position of User BARANGAY CHAIRMAN
Date Filed (mm/dd/yyyy) January 8, 2022

Signature of Head of Agency (affix signature here)

Fullname of Head of Agency IAN HERO SANTOS SOLIVEN
Designation of Head of Agency BARANGAY CHAIRMAN

this part is for the BTr system admin

generated username issoliven_r8_leyte_14_ad Leyte Leyte leyte
date created (mm/dd/yyyy) SOLIVEN SOLIVEN soliven

Signature of User Admin

Fullname of User Admin
Designated BTr office R8 - Leyte

*if you are applying as NGA/LGU/GOCC/GFI Admin, please submit the accomplished form to your designated BTr field office
or email to this address northernleyte@treasury.gov.ph for Northern Leyte and Biliran Provinces