CLIENT *

PARAMOUNT HUMAN RESOURCE

MULTI-PURPOSE COOPERATIVE

MEMBERSHIP AND EMPLOYMENT AGREEMENT

* MR./MS. ___________________________________
* ADDRESS: ________________________________

*
Dear: MR./MS. ____________________,

Congratulations!

Your application for membership with Paramount Human Resource Multi-Purpose

Cooperative (PHRMPC) has been approved and accepted by the Board of Directors,
subject to the terms and conditions of the cooperative By-Laws, and to the payment of P
1,500.00 membership fee.

One of the cooperative’s lines of business is to provide services under service contracts. In
relation to this, PHRMPC derives its income from capital build up of members and from
service fees paid as a result of said service contracts for services rendered by the
cooperative. Apart from being a member of the cooperative, you are also now an employee
of the cooperative and you may be assigned, if you so choose, to serve under one of the
cooperative’s various service agreements. Note, however, that you will not be entitled to a
share service surplus or service fee (your compensation for services to be rendered) unless
and until you are assigned to serve under a service contract and only for the duration of
each assignment, unless you perform other services for the cooperative in another official
capacity as approved by the cooperative. If you are interested in any of the different
endeavors that PHRMPC has with its various service contracts, you as member-owner-
employee are entitled to priority of assignment. You may apply for assignment to any of
the clients in writing which shall be subject to approval by the Board of Directors
depending upon your qualifications and the required services of a particular service
contract. Upon approval you will received an ASSIGNMENT NOTE, which shall indicate
the name and address where you render services, the nature of the service to be rendered,
the service fees, the duration of your assignment, which shall be co-terminus with the
particular service contract, and other details as may be necessary.

You are entitled to withdraw your shares/dividends from the earnings of the cooperative in
proportion to your contributions and service fees on an annual basis, subject to the
provisions of the PHRMPC By-Laws and the Cooperative Code of the Philippines.
However, upon your written request, you may avail of cash advances from your available
cooperative shares not more than twice per month.

Very truly yours,

________________________
HR Admin Assistant Manager

Received Copy:

*_____________________
Signature Over Printed Name

Unit 1303 The One Executive Office Building

Brgy. Nayong Kanluran, Quezon City
Telephone No. (02) 448-5688 . Telefax (02) 412-6354
Website: www.paramountmpc.org
 Paramount Human Resource Multi-Purpose Cooperative
_______________________________________________________
_______________________________________________________

APPLICATION FOR MEMBERSHIP

APPLICANT: * ____________________________________
Date Applied: * __________________________
Address:* ____________________________________
Tel. No./ CP No.* __________________________
Date of Birth: * ____________________________________
Civil Status: * _________________________
Place of Birth: * _______________________________________________________________________
Citizenship: * _______________________Sex:_____________________Religion:_______________
* *
Name of Spouse: * _______________________________________________________________________
Occupation: * _______________________________________________________________________

* Name of Children: * Date of Birth

______________________________________________
________________________ _________________________________
_______________________________________
________________________ _________________________________
_______________________________________
________________________ _________________________________
_______________________________________
________________________ _________________________________

* Father's Name: ________________________ * Occupation: __________________________

* Mother's Name: ________________________ * Occupation: __________________________

* Educational Background:
Elementary: ____________________________________
Date Graduated: __________________________
High School: ________________________________ Date Graduated: __________________________
College: ____________________________________
Date Graduated:
Course: _______________________________________________________________________

* Employment Record: ( Start from present to last employment )

From To Position Company
ny
__________________________________
________________ _____________ _____________________
__________________________________
________________ _____________ _____________________
__________________________________
________________ _____________ _____________________
__________________________________
________________ _____________ _____________________

* Character References:
Name Address Position Tel No.
__________________________________
________________________________ _____________ _____________________
__________________________________
________________________________ _____________ _____________________
__________________________________
________________________________ _____________ _____________________
__________________________________
________________________________ _____________ _____________________

I certify that the above information are true and correct, and any untruthful herein will be a ground
for my disqualification or dismembership.

*_______________________________________
Name of Applicant / Signature

Com. Tax Cert. No. _______________

Issued on: _______________
Issued at: _______________
SSS no.: * _______________
TIN no.: * _______________
PhilHealth: * _______________
Pag-Ibig: _______________
*
 PARAMOUNT HUMAN RESOURCE MULTI-PURPOSE COOPERATIVE
Recent
The One Executive Office Building Photo
Brgy. Nayong Kanluran,Delta, West Ave. Quezon City

APPLICATION FORM
PLS WRITE LEGIBLY AND DO NOT LEAVE ANY SPACES BLANK, WRITE NONE OR N/A (NOT APPLICABLE) FOR NO ENTRIES.
POSITION APPLIED: DATE: ____________
VIII. CHARACTERS REFERENCES
_______________________, 202__

I_______________________________, hereby authorize the Paramount Human Resource Multi-Purpose

Cooperative to deduct the amount of ONE THOUSAND FIVE HUNDRED PESOS ONLY (Php.
1,500.00) from my share in the service surplus as my voluntary payment for my membership to the
cooperative. The said amount shall be deducted in partial: in the amount of ONE HUNDRED FIFTY
PESOS ONLY (Php. 150.00) per cut off until the full amount is completed.

________________________________
Signature over printed name
 PMRF
PHILHEALTH MEMBER REGISTRATION FORM
UHC v.1 January 2020

REMINDERS: *
PHILHEALTH IDENTIFICATION NUMBER (PIN)
1. Your PhilHealth Identification Number (PIN) is your unique and permanent
PURPOSE:
number.
2. Always use your PIN in all transactions with PhilHealth. REGISTRATION X UPDATING/AMENDMENT
3. For Updating/Amendment check the appropriate box and provide details to Preferred KonSulTa Provider
be accomplished and submit corresponding supporting documents.
4. Please read instructions at the back before filling-out this form.

I. PERSONAL DETAILS
NAME NO
MIDDLE MONONYM
LAST NAME FIRST NAME EXTENSION MIDDLE NAME NA ME
(Jr./Sr./III)
(Check i f app li cable onl y)

* MEMBER
MOTHER’s
* MAIDEN NAME
SPOUSE
(If Married)

DATE OF BIRTH * PLACE OF BIRTH (City/Municipality/Province/Country)

(Please indicate country if born outside the Philippines) PHILSYS ID NUMBER (Optional)

m m d d y y y y *
SEX * CIVIL STATUS * CITIZENSHIP TAX PAYE R IDE NTIFICATION NUMBER (TIN) (Optional)
Male Single
Married
Annulled
Widow/er
x FILIPINO FOREIGN NATIONAL
Female DUAL CITIZEN
Legally Separated

II. ADDRESS and CONTACT DETAILS

PERMANENT HOME ADDRESS Hom e Phone Number
* Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name

(COUN TRY C OD E + AR EA CODE + TEL EPHONE NUM BER)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code
* Mobile Number (Required)
*
MAILING ADDRESS SAME AS ABOVE
Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name Bus iness (Direct Line)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code E-mail Address (Required for OFW)

III. DECLARATION OF DEPENDENTS (Use additional form if necess ary )

DATE OF NO Chec k if
NA ME MIDDLE MONONYM
BIRT H with
LAST NAME FIRST NAME EXTENSION
(Jr./Sr./III)
MIDDLE NAME RELATIONSHIP
(mm-dd-yyyy)
CITIZENSHIP NA ME Per manent
Disa bility
(Check i f app li cable onl y)

IV. MEMBER TYPE

DIRECT CONTRIBUTOR INDIRECT CONTRIBUTOR
Employed Private Kasambahay Family Driver
Listahanan LGU-sponsored
Employed Government Migrant Worker
4Ps/MCCT NGA-sponsored
Professional Practitioner Land-Based Sea-Based
Senior Citizen Private-sponsored
Self-Earning Individual Lifetime Member
Filipinos with Dual Citizenship / Living Abroad PAMANA Person with Disability
Individual
KIA/KIPO PWD ID No. ______________
Sole Proprietor Foreign National
Group Enrollment Scheme PRA SRRV No. _____________________ Bangsamoro/Normalization
____________________ ACR I-Card No. _____________________
For PhilHealth Use only:
PROFESSION: (Except Employed, Lifetime Members and MONTHLY INCOME: PROOF OF INCOME: Point of Service (POS) Financially Incapable
Sea-based Migrant Worker)
Financially Incapable

This form ma y be reproduce d and is not f or sale Continue at the bac k

 V. UPDATING/AMENDMENT
Please check: FROM TO
Change/Correction of Name
(Last Name, First N ame, Name Extension (Jr./Sr./III) Middle Name)

Correction of Date of Birth

Correction of Sex

Change of Civil Status

Updating of Personal Information/Address/

Telephone Number/Mobile Number/e-mail
Address

FOR PHILHEALTH USE ONLY

Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
authorize PhilHealth for the subsequent validation, verification and for other data sharing
RECEIVED BY:
purposes only under the following circumstances:

 As necessary for the proper execution of processes related to the legitimate and Full Name:
declared purpose;
 The use or disclosure is reasonably necessary, required or authorized by or under the ______________________________
law; and,
 Adequate security measures are employed to protect my information. PRO/LHIO/Branch:

_____________________________

Date & Time:

*_________________________________________________ *_________________
Member’s Signature over Printed Name Date Plea se affix right
______________________________
thumbmark if unable to write

INSTRUCTIONS

1. All information should be written in UPPER CASE/CAPITAL LETTERS. If the information is not applicable, write “N/A.”
2. All fields are mandatory unless indicated as optional. By affixing your signature, you certify the truthfulness and accuracy of all
information provided.
3. A properly accomplished PMRF shall be accompanied by a valid proof of identity for first time registrants, and supporting
documents to establish relationship between member and dependent/s for updating or request for amendment.
4. On the PURPOSE, check the appropriate box if for Registration or for Updating/Amendment of information.
5. Indicate preferred KonSulTa provider near the place of work or residence.
6. For PERSONAL DETAILS, all name entries should follow the format given below. Check the appropriate box if registrant has no
middle name and/or with single name (mononym).

LAST NAME FIRST NAME NAME EXTENSION (Jr./Sr./III) MIDDLE NAME

SANTOS JUAN ANDRES III DELA CRUZ

7. Indicate registrant’s/member’s name as it appears in the birth certificate.

8. The full mother’s maiden name of registrant/member must be indicated as it appears in the birth certificate.
9. Indicate the full name of spouse if registrant/member is married.
10. Indicate the complete permanent and mailing addresses and contact numbers.
11. For updating/amendment, check the appropriate box to be updated/amended and indicate the correct data.
12. For MEMBER TYPE, check the appropriate box which best describes your current membership status.
13. For Direct Contributors, except employed, sea-based migrant workers and lifetime members, indicate the profession, monthly
income and proof of income to be submitted.
14. For Self-earning individuals, Kasambahays and Family Drivers, indicate the actual monthly income in the space provided.
15. In declaring dependents, provide the full name of the living spouse, children below 21 years old, and parents who are 60 years old
and above totally dependent to the member.
16. Dependents with disability shall be registered as principal members in accordance with Republic Act 11228 on mandatory
PhilHealth coverage for all persons with disability (PWD).
17. The registrant must affix his/her signature over printed name (or right thumbmark if unable to write) and indicate the date when the
PMRF was signed.
 PMRF
PHILHEALTH MEMBER REGISTRATION FORM
UHC v.1 January 2020

REMINDERS: *
PHILHEALTH IDENTIFICATION NUMBER (PIN)
1. Your PhilHealth Identification Number (PIN) is your unique and permanent
PURPOSE:
number.
2. Always use your PIN in all transactions with PhilHealth. REGISTRATION X UPDATING/AMENDMENT
3. For Updating/Amendment check the appropriate box and provide details to Preferred KonSulTa Provider
be accomplished and submit corresponding supporting documents.
4. Please read instructions at the back before filling-out this form.

I. PERSONAL DETAILS
NAME NO
MIDDLE MONONYM
LAST NAME FIRST NAME EXTENSION MIDDLE NAME NA ME
(Jr./Sr./III)
(Check i f app li cable onl y)

* MEMBER
MOTHER’s
* MAIDEN NAME
SPOUSE
(If Married)

DATE OF BIRTH * PLACE OF BIRTH (City/Municipality/Province/Country)

(Please indicate country if born outside the Philippines) PHILSYS ID NUMBER (Optional)

m m d d y y y y *
SEX * CIVIL STATUS * CITIZENSHIP TAX PAYE R IDE NTIFICATION NUMBER (TIN) (Optional)
Male Single
Married
Annulled
Widow/er
x FILIPINO FOREIGN NATIONAL
Female DUAL CITIZEN
Legally Separated

II. ADDRESS and CONTACT DETAILS

PERMANENT HOME ADDRESS Hom e Phone Number
* Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name

(COUN TRY C OD E + AR EA CODE + TEL EPHONE NUM BER)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code
* Mobile Number (Required)
*
MAILING ADDRESS SAME AS ABOVE
Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name Bus iness (Direct Line)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code E-mail Address (Required for OFW)

III. DECLARATION OF DEPENDENTS (Use additional form if necess ary )

DATE OF NO Chec k if
NA ME MIDDLE MONONYM
BIRT H with
LAST NAME FIRST NAME EXTENSION
(Jr./Sr./III)
MIDDLE NAME RELATIONSHIP
(mm-dd-yyyy)
CITIZENSHIP NA ME Per manent
Disa bility
(Check i f app li cable onl y)

IV. MEMBER TYPE

DIRECT CONTRIBUTOR INDIRECT CONTRIBUTOR
Employed Private Kasambahay Family Driver
Listahanan LGU-sponsored
Employed Government Migrant Worker
4Ps/MCCT NGA-sponsored
Professional Practitioner Land-Based Sea-Based
Senior Citizen Private-sponsored
Self-Earning Individual Lifetime Member
Filipinos with Dual Citizenship / Living Abroad PAMANA Person with Disability
Individual
KIA/KIPO PWD ID No. ______________
Sole Proprietor Foreign National
Group Enrollment Scheme PRA SRRV No. _____________________ Bangsamoro/Normalization
____________________ ACR I-Card No. _____________________
For PhilHealth Use only:
PROFESSION: (Except Employed, Lifetime Members and MONTHLY INCOME: PROOF OF INCOME: Point of Service (POS) Financially Incapable
Sea-based Migrant Worker)
Financially Incapable

This form ma y be reproduce d and is not f or sale Continue at the bac k

 V. UPDATING/AMENDMENT
Please check: FROM TO
Change/Correction of Name
(Last Name, First N ame, Name Extension (Jr./Sr./III) Middle Name)

Correction of Date of Birth

Correction of Sex

Change of Civil Status

Updating of Personal Information/Address/

Telephone Number/Mobile Number/e-mail
Address

FOR PHILHEALTH USE ONLY

Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
authorize PhilHealth for the subsequent validation, verification and for other data sharing
RECEIVED BY:
purposes only under the following circumstances:

 As necessary for the proper execution of processes related to the legitimate and Full Name:
declared purpose;
 The use or disclosure is reasonably necessary, required or authorized by or under the ______________________________
law; and,
 Adequate security measures are employed to protect my information. PRO/LHIO/Branch:

_____________________________

Date & Time:

*_________________________________________________ *_________________
Member’s Signature over Printed Name Date Plea se affix right
______________________________
thumbmark if unable to write

INSTRUCTIONS

1. All information should be written in UPPER CASE/CAPITAL LETTERS. If the information is not applicable, write “N/A.”
2. All fields are mandatory unless indicated as optional. By affixing your signature, you certify the truthfulness and accuracy of all
information provided.
3. A properly accomplished PMRF shall be accompanied by a valid proof of identity for first time registrants, and supporting
documents to establish relationship between member and dependent/s for updating or request for amendment.
4. On the PURPOSE, check the appropriate box if for Registration or for Updating/Amendment of information.
5. Indicate preferred KonSulTa provider near the place of work or residence.
6. For PERSONAL DETAILS, all name entries should follow the format given below. Check the appropriate box if registrant has no
middle name and/or with single name (mononym).

LAST NAME FIRST NAME NAME EXTENSION (Jr./Sr./III) MIDDLE NAME

SANTOS JUAN ANDRES III DELA CRUZ

7. Indicate registrant’s/member’s name as it appears in the birth certificate.

8. The full mother’s maiden name of registrant/member must be indicated as it appears in the birth certificate.
9. Indicate the full name of spouse if registrant/member is married.
10. Indicate the complete permanent and mailing addresses and contact numbers.
11. For updating/amendment, check the appropriate box to be updated/amended and indicate the correct data.
12. For MEMBER TYPE, check the appropriate box which best describes your current membership status.
13. For Direct Contributors, except employed, sea-based migrant workers and lifetime members, indicate the profession, monthly
income and proof of income to be submitted.
14. For Self-earning individuals, Kasambahays and Family Drivers, indicate the actual monthly income in the space provided.
15. In declaring dependents, provide the full name of the living spouse, children below 21 years old, and parents who are 60 years old
and above totally dependent to the member.
16. Dependents with disability shall be registered as principal members in accordance with Republic Act 11228 on mandatory
PhilHealth coverage for all persons with disability (PWD).
17. The registrant must affix his/her signature over printed name (or right thumbmark if unable to write) and indicate the date when the
PMRF was signed.
(To be filled out by BIR) DLN: _________________
BIR Form No.
Republic of the Philippines
Application for Registration
Department of Finance
Bureau of Internal Revenue 1902
January 2018 (ENCS)
For Individuals Earning Purely Compensation Income
(Local and Alien Employee)
- - - 0 0 0 0 0
New TIN to be issued, if applicable (To be filled out by BIR)
Fill in all applicable white spaces. Write “NA” for those not applicable. Mark all appropriate boxes with an “X”
Part I - Taxpayer/Employee Information
1 PhilSys Number (PSN) 2 Taxpayer Type 3 BIR Registration Date
(To be filled out by BIR) (MM/DD/YYYY)

Local Resident Alien Special Non-Resident Alien

4 Taxpayer Identification Number (TIN) 5 RDO Code
(For Taxpayer with existing TIN) * - - - 0 0 0 0 0 (To be filled out by BIR)

6 Taxpayer’s Name
* Last Name First Name

Middle Name Suffix 7 Gender

*
Male Female

8 Civil Status * Single Married Widow/er Legally Separated

9 Date of Birth (MM/DD/YYYY) * 10 Place of Birth *

11 Mother’s Maiden Name (First Name, Middle Name, Last Name) *

12 Father’s Name (First Name, Middle Name, Last Name) *

13 Citizenship * 14 Other Citizenship

15 Local Residence Address

Unit/Room/Floor/Building No. * Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

16 Foreign Address

17 Municipality Code
(To be filled out by BIR) 18 Tax Type ,INCOME1TAX, 19 Form Type ,BIR Form1No. 1700 , 20 ATC II,011.
21 Identification Details (e.g. passport, government issued ID, company ID, etc.)
Type Number Effective Date (MM/DD/YYYY) Expiry Date (MM/DD/YYYY)

Issuer Place/Country of Issue

22 Preferred Contact Type Landline No. Mobile Number

Email Address (required)

Part II - Spouse Information (if applicable)

23 Employment Status of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
24 Spouse Name
Last Name First Name

Middle Name Suffix 25 Spouse TIN

- - - 0 0 0 0 0
26 Spouse Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

27 Spouse Employer’s TIN - - -

 BIR Form No. 1902-page 2
Part III - For Employee with Two or More Employers (Multiple Employments) Within the Calendar Year
28 Type of Multiple Employments
Successive Employments (With previous employer/s within the calendar year)
Concurrent Employments (With two or more employers at the same time within the calendar year)
(If successive, enter previous employer/s; if concurrent, enter secondary employer/s )
Previous and/or Concurrent Employments During the Calendar Year
29A Name of Employer

29B TIN of Employer

30A Name of Employer

30B TIN of Employer

31A Name of Employer

31B TIN of Employer

32 Declaration
I declare under the penalties of perjury that this application, and all its attachments, have been made in good faith, verified by me and to the best of my
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority
thereof. Further, I give my consent to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful
purposes.

*________________________________________
Taxpayer(Employee)/Authorized Representative
(Signature over Printed Name)
Part IV – Primary/Current Employer Information
33 Type of Registering Office 34 TIN
- - - 35 RDO Code
Head Office Branch Office
36 Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

37 Employer’s Address
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

38 Contact Details
Landline Number Fax Number Mobile Number

39 Relationship Start Date/Date Employee was Hired 40 Municipality Code (To be filled out by BIR)
(MM/DD/YYYY)
41 Declaration Stamp of BIR Receiving Office
I declare under the penalties of perjury that this application and all its attachments, have been made in good faith, verified by me and Date of Receipt
and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as
amended, and the regulations issued under authority thereof. Further, I give my consent to the processing of my information as
contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

_______________________________________ __________________________
EMPLOYER/AUTHORIZED REPRESENTATIVE Title/Position of Signatory
(Signature over Printed Name)
*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)

Documentary Requirements:

For Local Employee: For Alien Employee:

1. Any identification issued by an authorized government body (e.g. Birth 1. Passport
Certificate, Passport, Driver’s License, etc.) that shows the name, 2. Working Permit or photocopy of duly received Application for Alien
address and birthdate of the applicant. Employment (AEP) by the Department of Labor and Employment
2. Marriage Contract, if applicable. (DOLE)

POSSESSION OF MORE THAN ONE TAXPAYER IDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT TO THE
PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED.
(To be filled out by BIR) DLN: _________________
BIR Form No.
Republic of the Philippines
Application for Registration
Department of Finance
Bureau of Internal Revenue 1902
January 2018 (ENCS)
For Individuals Earning Purely Compensation Income
(Local and Alien Employee)
- - - 0 0 0 0 0
New TIN to be issued, if applicable (To be filled out by BIR)
Fill in all applicable white spaces. Write “NA” for those not applicable. Mark all appropriate boxes with an “X”
Part I - Taxpayer/Employee Information
1 PhilSys Number (PSN) 2 Taxpayer Type 3 BIR Registration Date
(To be filled out by BIR) (MM/DD/YYYY)

Local Resident Alien Special Non-Resident Alien

4 Taxpayer Identification Number (TIN) 5 RDO Code
(For Taxpayer with existing TIN) * - - - 0 0 0 0 0 (To be filled out by BIR)

6 Taxpayer’s Name
* Last Name First Name

Middle Name Suffix 7 Gender

*
Male Female

8 Civil Status * Single Married Widow/er Legally Separated

9 Date of Birth (MM/DD/YYYY) * 10 Place of Birth *

11 Mother’s Maiden Name (First Name, Middle Name, Last Name) *

12 Father’s Name (First Name, Middle Name, Last Name) *

13 Citizenship * 14 Other Citizenship

15 Local Residence Address

Unit/Room/Floor/Building No. * Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

16 Foreign Address

17 Municipality Code
(To be filled out by BIR) 18 Tax Type ,INCOME1TAX, 19 Form Type ,BIR Form1No. 1700 , 20 ATC II,011.
21 Identification Details (e.g. passport, government issued ID, company ID, etc.)
Type Number Effective Date (MM/DD/YYYY) Expiry Date (MM/DD/YYYY)

Issuer Place/Country of Issue

22 Preferred Contact Type Landline No. Mobile Number

Email Address (required)

Part II - Spouse Information (if applicable)

23 Employment Status of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
24 Spouse Name
Last Name First Name

Middle Name Suffix 25 Spouse TIN

- - - 0 0 0 0 0
26 Spouse Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

27 Spouse Employer’s TIN - - -

 BIR Form No. 1902-page 2
Part III - For Employee with Two or More Employers (Multiple Employments) Within the Calendar Year
28 Type of Multiple Employments
Successive Employments (With previous employer/s within the calendar year)
Concurrent Employments (With two or more employers at the same time within the calendar year)
(If successive, enter previous employer/s; if concurrent, enter secondary employer/s )
Previous and/or Concurrent Employments During the Calendar Year
29A Name of Employer

29B TIN of Employer

30A Name of Employer

30B TIN of Employer

31A Name of Employer

31B TIN of Employer

32 Declaration
I declare under the penalties of perjury that this application, and all its attachments, have been made in good faith, verified by me and to the best of my
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority
thereof. Further, I give my consent to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful
purposes.

*________________________________________
Taxpayer(Employee)/Authorized Representative
(Signature over Printed Name)
Part IV – Primary/Current Employer Information
33 Type of Registering Office 34 TIN
- - - 35 RDO Code
Head Office Branch Office
36 Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

37 Employer’s Address
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

38 Contact Details
Landline Number Fax Number Mobile Number

39 Relationship Start Date/Date Employee was Hired 40 Municipality Code (To be filled out by BIR)
(MM/DD/YYYY)
41 Declaration Stamp of BIR Receiving Office
I declare under the penalties of perjury that this application and all its attachments, have been made in good faith, verified by me and Date of Receipt
and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as
amended, and the regulations issued under authority thereof. Further, I give my consent to the processing of my information as
contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

_______________________________________ __________________________
EMPLOYER/AUTHORIZED REPRESENTATIVE Title/Position of Signatory
(Signature over Printed Name)
*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)

Documentary Requirements:

For Local Employee: For Alien Employee:

1. Any identification issued by an authorized government body (e.g. Birth 1. Passport
Certificate, Passport, Driver’s License, etc.) that shows the name, 2. Working Permit or photocopy of duly received Application for Alien
address and birthdate of the applicant. Employment (AEP) by the Department of Labor and Employment
2. Marriage Contract, if applicable. (DOLE)

POSSESSION OF MORE THAN ONE TAXPAYER IDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT TO THE
PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED.
 PARAMOUNT HUMAN RESOURCE
MULTI-PURPOSE COOPERATIVE

PAGPAPAUBAYA/AWTORISASYON SA PAG PROSESO NG TIN NUMBER

Ako si, , may sapat na gulang at kasalukuyang naninirahan sa

. Ako ay miyembro ng PARAMOUNT HUMAN
RESOURCE MULTI PURPOSE COOPERATIVE (PHRMPC) na nakadestino sa aming
kliyente bilang isang ____________________________ ay
nagpapaubaya at pinapahintulutan ang Paramount Human Resource Multi-Purpose Cooperative
na i-proseso ang aking TAXPAYER IDENTIFICATION NUMBER.

Maraming Salamat po.

PETSA AT LAGDA PANGALAN NG MANGGAGAWA

Unit 1303 The One Executive Office Building

Barangay Nayong Kanluran, Quezon City
Telephone No. (02) 448-5688 • Telefax (02) 412-6354
Website: www.paramountmpc.org
 PARAMOUNT HUMAN RESOURCE MULTI-PURPOSE COOPERATIVE
ORIENTATION AND TRAINING CLEARANCE
NEW HIRE INFORMATION
NAME: * STORE/ BRANCH: *
POSITION: * CELLPHONE #: *
TEAM: EMAIL ADD:
*
SCOPE OF NEW MEMBERS ORIENTATION DATE OF ORIENTATION:
EXPLAIN/DISCUSS:
INTRODUCTION GOVERNMENT MANDATORY: SSS

PARAMOUNT HRMPC BRIEF HISTORY AND BACKGROUND GOVERNMENT MANDATORY: PHILHEALTH

CAPITAL BUILD-UP (CBU) GOVERNMENT MANDATORY: PAG-IBIG

COOPERATIVES INTEREST/MEM-FEE OPERATIONS: RECEIVING PAY-OUT

MEMBERHIP BENEFITS: FREE TRAINING OPERATIONS: TERMINATION OF MEMBERSHIP

MEMBERSHIP BENEFITS: CONTINUOUS ASSIGNMENT OPERATIONS:BASIC FORMS AND DOCUMENTS

MEMBERSHIP BENEFITS: HOLIDAY PAY AND SERVICE INCENTIVE
OPERATIONS:BUILDING POLICIES
LEAVE
MEMBERSHIP BENEFITS: IN HOUSE LOAN FACILITIES ENDORSEMENT TO CLIENT

MEMBERSHIP BENEFITS: DIVIDENDS & SHARED INTEREST OTHERS: __________________________

MEMBERSHIP BENEFITS: ACCIDENT AND DEATH ASSISTANCE
OTHERS: __________________________
BENEFIT

SIGNATURE OVER PRINTED NAME OF ATTENDEES SIGNATURE OVER PRINTED NAME OF PRESENTER

NOTED BY:

HR A CCOUNT MA NA GER/SUPERVISOR LEARNING & DEVELOPMENT MNGR.

2021 version

TRAINING TOPICS
Explain/Discuss: DATE TRAINEE FACILITATOR
VISION, MISSION AND VALUES OF THE
COOPERA TIVE
WORK ETHICS

OCCUPATIONAL SA FETY AND HEALTH ORIENTATION

SEXUAL HARRAASSMENT
VIOLENCE AGAINST WOMEN AND THEIR CHILDREN
(VAWC)
CONFLICT OF INTEREST

CONFIDENTIA LITY

MOBILE DTR A PPLICATION (SYSTEM)

HEALTH CARE ORIENTATION

NOTED BY:

KSS
LEARNING & DEVELOPMENT MNGR.

2021 version

TRAINING TOPICS
Explain/Discuss: DATE TRAINEE FACILITATOR

PDTP: FOOD SA FETY

PDTP: PRODUCT ORIENTATION

PDTP: CUSTOMER SERVICE

PDTP: GOOD GROOMING

PDTP: BASIC 5S

OTHERS:____________________________________

OTHERS:____________________________________

OTHERS:____________________________________

NOTED BY:

KSS
LEARNING & DEVELOPMENT MNGR.

2021 version
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 Ako si

na naka-assign sa ________________________________________________

ay pinapahintulutan ang Paramount Human Resource Multi-Purpose

Coopearative na ihulog ang aking sahod / last claims sa aking BDO
Cash Card / Metrobank Account.

Ang aking BDO Cash Card / Metrobank Account ay

Habang ako ay wala pang BDO Cash Card / Metrobank Account,

aking pinapahintulutan ang Paramount Human Resource Multi-
Purpose Cooperative na ihulog ang aking sahod / last claims sa
MLhuillier o Palawan.

Tirahan

(Numero ng Cellphone)

Akin ding binibigyan ng authority ang Paramount Human Resource

Multi-Purpose Cooperative na ikaltas sa aking sahod / last claims ang
halaga ng service charge sa MLhuillier, Palawan, BDO Cash Card o
Metrobank.

(Pangalan at Lagda / Petsa)

 Ako si

na naka-assign sa ________________________________________________

ay pinapahintulutan ang Paramount Human Resource Multi-Purpose

Coopearative na ihulog ang aking sahod / last claims sa aking BDO
Cash Card / Metrobank Account.

Ang aking BDO Cash Card / Metrobank Account ay

Habang ako ay wala pang BDO Cash Card / Metrobank Account,

aking pinapahintulutan ang Paramount Human Resource Multi-
Purpose Cooperative na ihulog ang aking sahod / last claims sa
MLhuillier o Palawan.

Tirahan

(Numero ng Cellphone)

Akin ding binibigyan ng authority ang Paramount Human Resource

Multi-Purpose Cooperative na ikaltas sa aking sahod / last claims ang
halaga ng service charge sa MLhuillier, Palawan, BDO Cash Card o
Metrobank.

(Pangalan at Lagda / Petsa)