Share

Household Employer Unified Registration Form

Pag-Ibig form for household unified registration

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: HQP-ITF-033
(V03, 05/2017)

eSRS EMPLOYER ENROLLMENT FORM

Employer ID Number
Employer Name

:

Pag-IBIG Servicing Branch
Employer Type (e.g, Private or Government)

:

:

:

ADDRESS AND CONTACT DETAILS
Unit/Room No., Floor

Building Name

AREA CODE

TELEPHONE NUMBER

Business (Direct Line)
Lot No., Block No.

Phase No.

House No.

Subdivision

Street Name
Business (Trunk Line)

Barangay

Local

Cell Phone

Municipality/City
Province

Business Email Address

Zip Code

AUTHORIZED USER DETAILS
Pag-IBIG MID Number

:

User Name

:

Name

:

Email Address

:

Designation

:

Cell Phone Number

:

EMPLOYER’S CERTIFICATION
We certify that the information herein stated is true and correct; that we shall be responsible for all the information
provided by our Authorized User/s to Pag-IBIG Fund; that we consent to the disapproval or cancellation of our
enrolment, and/or termination of our access to the facility in case of falsification, misrepresentation or any similar acts
committed by our Authorized User/s.
____________________________
Authorized Signatory
(Signature Over Printed Name)

______________________________
Designation

_______________
Date

FOR Pag-IBIG Fund USE ONLY
Approved by:

____________________________
Authorized Signatory
(Signature Over Printed Name)

______________________________
Position/Designation

_______________
Date
 
Page of
Share