Pag Ibig
Pag Ibig
Pag Ibig
BRANCH/OFFICE
TYPE OF EMPLOYER Building Name Lot No., Block No., Phase No. House No. Private Government Household ZIP Code
Street Name
Subdivision
Barangay
Municipality/City
Pag-IBIG II
NAME OF MEMBERS First Name Name Extension (Jr., III, etc.)
Modified Pag-IBIG II
Middle Name ACCOUNT NO. MONTHLY COMPENSATION CONTRIBUTIONS
EMPLOYEE SHARE EMPLOYER SHARE TOTAL
REMARKS
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EMPLOYER CERTIFICATION
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 (Signature Over Printed Name)
__________________________________
DESIGNATION/POSITION
_________________________
DATE
(Revised 03/2011)
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The maximum Monthly Compensation to be used in computing the employee and employer contributions shall not be more than 5,000.00. A member may contribute more than what is required, however the employer shall only be mandated to contribute two percent (2%) of the monthly compensation of the member as counterpart contribution. In case the member increases his/her monthly membership contribution, the employer shall have the option to match said increase or to contribute only what is required. f. Membership contribution payments to be remitted should be equal to the total amount reflected in the MCRF. Check payments should be made payable to HDMF and shall be posted upon clearing. g. Employers with over remittance from previous payments shall be issued with a Notice of Overpayment and Credit Memo. For remittances previously made for employees for whom remittances should not have been made, the employer shall request a refund subject to the Funds verification and approval. The request shall be made not later than six (6) months from the time said remittance was made. h. Employers who shall remit on or before the due date as evidenced by the validated Membership Contribution Remittance Form (MCRF) or Pag-IBIG Fund Receipt shall be entitled to an incentive fee equivalent to 0.2% of the amount remitted provided he satisfy all the conditions required.
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12-14
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15
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- Newly Hired - Leave Without Pay/AWOL - Resigned/Separated - Retired - Deceased - Others, please specify reason
L RS RT D O
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Indicate the number of members listed in this page. Indicate the total number of members listed if this is the last page of the listing. Indicate the total amount due and employer contributions per page Indicate the grand total amount due and employer contributions if this is the last page Employer Certification - to be accomplished and duly signed by the Head of Office/Authorized Representative.