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TMF190 ESRSEmployerEnrollmentForm V05

This document is an employer enrollment form for Pag-IBIG Fund. It collects information such as the employer ID number, name, address, contact details, and authorized user details. The employer certifies that the information provided is true and correct. The employer authorizes Pag-IBIG Fund to collect, organize, use, and process personal data as part of the employer information. The form requires signatures from the authorized signatory and a Pag-IBIG Fund official.

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dylan
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1K views1 page

TMF190 ESRSEmployerEnrollmentForm V05

This document is an employer enrollment form for Pag-IBIG Fund. It collects information such as the employer ID number, name, address, contact details, and authorized user details. The employer certifies that the information provided is true and correct. The employer authorizes Pag-IBIG Fund to collect, organize, use, and process personal data as part of the employer information. The form requires signatures from the authorized signatory and a Pag-IBIG Fund official.

Uploaded by

dylan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HQP-TMF-190

(V05, 12/2020)

Pag-IBIG Fund

eSRS EMPLOYER ENROLLMENT FORM

Employer ID Number :
Employer/Business 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. Street Name

Subdivision Barangay
Business (Trunk Line) Local

Municipality/City Province
Cell Phone Number
Region Zip Code
Business Email Address

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 the 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.
Likewise, we hereby authorize Pag-IBIG Fund to collect record, organize, update/modify, use,
consolidate, block, erase or destruct the personal data as part of our information. We hereby affirm our
rights to: (a) be informed; (b) object to processing; (c) access; (d) rectify, suspend or withdraw our
personal data; (e) damages; and (f) data portability pursuant to the provision of R.A. No. 10173 (Data
Privacy Act of 2012).

(Signature Over Printed Name) (Designation) (Date)


Authorized Signatory

FOR Pag-IBIG Fund USE ONLY

Approved by:

(Signature Over Printed Name) (Designation) (Date)


Authorized Signatory

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