HQP-PFF-053

Remmmce Foam (MSRF) ‘

NOTE: PLEASE READ INSTRUCTIONS AT THE BA CK.
EMPLOYER/BUSINESS ADDRESS
NAME OF MEMBERS
AcEl%l_JNT M53833?-JIIP Last Name First Name Nizreifixtggjion Middle Name conI::gJ:k-
EON -1 I - TOTAL jjj—ZjIZZZ jjj—ZjIZZZ jjj—ZjIIZZ jjj—jj11ZZ jjj—ZjIIZZ jjj—ZjIIZZ jjj—ZjIZZZ
jjj—ZjIZZZ jjj—ZjIZZZ jjj—ZjIZZZ jjj—jjIZZZ jjj—ZjIIZZ jj2—Zj11ZZ jT2—Zj11ZZ jjj—Zj11ZZ jjj
—ZjIZZZ jT2—Zj11ZZ jj Z-XXIX Zjj—Zj11ZZ jjj—Lj11Lj jjj—ZjIZZZ Zjj—Zj11ZZ jjj—Zj11ZZ jjj
—Zj11ZZ jjj—ZjIIZj Zjj—ZjIIZj j22—Zj11ZZ 11% 11% 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 REPRESENTATIVE
DESIGNATION/POSITION DATE (Signature Over Printed Name) THIS FORM MAY BE
REPRODUCED. NOT FOR SALE. (V03, 10/2016)
GUIDELINES AND INSTRUCTIONS
a- TYPe 0r Print all entries in BLOCK 0r CAPITAL LETTER3 i- Failure or refusal of the
Employer to pay or to remit the b- ACC0mPiieh this term in 50ttC0PY When making
remittances t0 P39-ii3iG Fund contributions herein prescribed shall not prejudice the right of
the 0r t0 an)’ aeeredited Coiieeting Partner based 0n the t0ii0WinQ PaYment covered
employee to the benefits under the Fund. Such Employer Scheduiei shall be charged a
penalty equivalent to 1/10 of 1%_ per day of s¢hedu|e of Payments delay of the amount due
starting on the first day immediately First Letter of Due Date following the due date until the
date of full settlement. Employer/Business Name A to D 10"‘ to the 14”‘ day of the month ®
Pag-IBIG Emp|oyer’s ID No. — assigned Pag-IBIG Emp|oyer’s ID E to L 15"“ to the 19'“ day
of the month Number- M to Q 20"‘ to the 24"‘ day of the month _ _ _ R to Z’ Numeral 25th at
the end of the month ® Employer/Business Name — Per DTI/SEC Registration. c. For
employer with branch offices, please prepare separate Membership _ _ _ _ Savings
Remittance Form (MSRF) for each branch indicating therein their E“TEti_°Yer:t"B”5'"°E'5t
£dd';55k'N'“d'|§:ie U':t"i/R°Ct’_|m N0-N H003 respective addresses ui ing ame or o I o., 0c 0.,
ase to. or ouse o.‘ an d. A separate MSRF should be accomplished per type of payment
(whether St":‘:t|PNgm:v S”bd'V'5'°”» Bata”9aY~ M'~”"C'Pai'tY/C'tYv P"°V'”Ce- cash or check
payment) and in case Credit Memo shall be applied as 3“ ° 9- FtaYrnentt°tite Ftintt @ Pag-
IBIG MID No. — indicate the members assigned Pag-IBIG 9- RATE OF 'V'E'V'BERS"”P
SAVWG3 (M3) Membership Identification (MID) Number. MONTHLY COMPENSATION
CONTRIBUTION RATE . . , . (BASIC + COLA) EMPLOYEE EMPLOYER To-t-AL Account No.
_— indicate the members assigned Account Number per Membership Program.

P150000 and below 1% 2% 3% NOTE: In accomplishing the Account Number column, for
0Ve|’P1.500-00 2% 2% 4% Pag-IBIG I contributions, indicate MID Number or RTN; for Pag-
IBIG II, indicate the assigned Account Number ; for MP2, The maximum Monthly
Compensation to be used in computing the employee indicate the system-generated Account
Number provided after and employer contribution shall not be more than 5,000.00. successfu|
enro||ment_ A member may contribute more than what is required, however the employer
shall only be mandated to contribute two percent (2%) of the monthly Memberehip Pr°9rar_n
— indicate if M5 remittance is t0r Pa9'iBiG compensation of the member as counterpart
contribution. In case the ® ii Pa9'iBiG it Or Meditied Pag-iBiG ii Program- member increases
hislher monthly membership savings, the emp|oyer_sha|| Name of Members _ indicate
memberis Complete heme th the have the option to match said increase or to contribute only
what is required. fettewthg format. Last Name First Name Name Extension (Jr. I” f.
Membership contribution payments to be remitted should be equal to the total eta), Middle
Name amount reflected in the MSRF. Check payments should be made payable to Pag-IBIG
Fund and shall be posted upon clearing (clearing policy shall not be applicable to National
Government Agency (NGA), instead payment shall be Period Covered — indicate the
applicable month and year of MS posted within 72 hours upon receipt of collection).
remittance in the following format (YYYYMM). g. Employers with over remittance from
previous payments shall be issued with a Notice of Overpayment and Credit Memo. For
remittances previously made Monthly Compensation — refer to the basic salary and other for
employees for whom remittances should not have been made, the allowances, where basic
salary includes, but is not limited to, fees, employer shall request a refund subject to the
Fund's verification and salaries, wages, and similar items received inamonth. Accomplish
approval. The request shall be made not later than six (6) months from the this portion only
when remitting the member's initial membership time said remittance was made. savings or if
here are changes in monthly compensation of the h. Employers who shall remit on or before
the due date as evidenced by the member. validated Membership Savings Remittance Form
(MSRF) or Pag-IBIG Fund _ _ _ _ Receipt shall be entitled to an incentive fee equivalent to
0.2% of the amount Mem_be"_5h'P 3aV'"95 ‘ ind‘ 9 the am°Unt °t emPi°Yee remitted
provided he satisfy all the conditions required. C°ntrii3Uti°n5 Under C°iU the am0Unt Of
emPi0Yer contributions under column , a he total amount of employee and employer
contributions under . Do not round off nor drop “‘“'"""”5’ centavos. . MEMBERSHIP SAVINGS
R k l. h th. rt. I t rt h . th RE""..I.nm:E Fan“ ttmsflfl emar s’— accomptis is po ion ony o repo c
anges in e _;m,_.___ mmmm, H m,_ employee s/members employment status and to update
any I int0rn1ati°n regarding the ernPi°Vee/rnentt>er- indicate the appropriate code and
effectivity date in the following format _. .. ._ , (mm/dd/yy) on the space provided for. Please
refer to the following Hfifimeii-:'iiii'1 - -‘_u_- %% %%===% N - Newt Hired Exam /es %% %
%===% y . '0 jjj ===j L - Leave Without PaylAWOL 1. N: 1/4/2010 %% %%==E% RS -
Resigned/Separated 2- L: 1/21/2010 jjj ::1j _ jjj ===j RT _ Rented 3_ R3; 1/3/2010 ‘ -‘Z22: I jjj
===j D - Deceased 4_ D_ 1/14/2010 jjj ::1j . %% %%===% ° ' Othersi Please 5P9°'tY “€350”
jjj ===j %% %%===% - - - --- 222- Indicate the total amount due and employer COnt|'|bUt|0nS
per page. jjj ===j a====a Indicate the total amount due and employer contributions if this is
®r the test page, “""-“*nN7$:1i:=:"‘7:fl775?7*m":5"“::V*w""_"‘m""'“"flimmmumwmmmwM"
Employer Certification - to be accomplished and duly signed by 7 @ I the Head of
Office/Authorized Representative.