USER ENROLMENT FORM v1

* all fields are required

USER INFORMATION*
Email Address d2321574@gmail.com
First Name JOACHIM VICTORINO
Middle Name CAJIGAS
Last Name DE JESUS
Position Title PUNONG BARANGAY

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

ORGANIZATION*
Department BARANGAY 616 ZONE 61 DISTRICT VI, MANILA
gency (Whole Name) (Acronym) 3471 3RD FLR. MAG. TORRES ST. BACOOD MANILA
Operating Unit

LOCATION*
Region NCR
Province/District District 1
Reference: Manila, San Juan City,
MANILA
Mandaluyong City
City/Municipality

SIGNATORIES *

Signature of the User

Fullname of User JOACHIM VICTORINO CAJIGAS DE JESUS
Position of User PUNONG BARANGAY
Date Filed (mm/dd/yyyy) May 13, 2024

Signature of Head of Agency

Fullname of Head of Agency JOACHIM VICTORINO C. DE JESUS
Designation of Head of Agency PUNONG BARANGAY

THIS PART IS TO BE FILLED BY THE BTR ADMIN

generated username jcdejesus_ncr_district1_lgu_ad District1 District1 district1

date created (mm/dd/yyyy) DEJESUS DEJESUS dejesus

Signature of User Admin

Fullname of User Admin
Designated BTr office NCR - District 1