HQP-PFF-053

MEMBERSHIP SAVINGS Pag-IBIG EMPLOYER’S ID NUMBER

REMITTANCE FORM (MSRF) 200961800004

NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.

EMPLOYER/BUSINESS NAME
SAFETY TRANSPORT INC
EMPLOYER/BUSINESS ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name

350 NEPA ST.

Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code

BALUT TONDO MANILA 1013

NAME OF MEMBERS MEMBERSHIP SAVINGS
Pag-IBIG ACCOUNT MEMBERSHIP PERIOD MONTHLY
Last Name First Name Name Extension Middle Name REMARKS
MID NO. NO. PROGRAM COVERED COMPENSATION
(Jr., III, etc.) EE ER
TOTAL
SHARE SHARE

121223408838 ASPIRIN MARTY CARPIO 09/2019 200.00 100 100

105002156027 ARIOLA NELSON NAZA 09/2019 200.00 100 100
105000876442 BUHISAN EMILIO MALINAO 09/2019 200.00 100 100
121059429009 CABINTOY ERNESTO JR. CREDO 09/2019 200.00 100 100
121203765231 CANLAS JULIUS DONAYRE 09/2019 200.00 100 100
121206973662 CARPIO JONIEMAR VASQUEZ 09/2019 200.00 100 100
121071564548 CRUZ JOVEN JR. RODICO 09/2019 200 .00 100 100
121053554261 DELOS SANTOS JOIL OBAUB 09/2019 200 .00 100 100
121240243584 DORONGON JULIUS BAYLON 09/2019 200.00 100 100
121192014219 GANAO ANTONINO ANDIAL 09/2019 200.00 100 100
121039280828 MEDINA JANOR RUBIO 09/2019 200.00 100 100
105000864629 ROBANTE ENRIQUE LAYAO 09/2019 200.00 100 100
121203343323 SANCHEZ DOMINADOR CARSELLER 09/2019 200.00 100 100
121222846068 SANCHEZ JULITO CARSELLER 09/2019 200.00 100 100
121220713440 SANCHEZ PATRICK PALILEO 09/2019 200.00 100 100
121193222295 SARIA ELEUSAR ALCANTARA 09/2019 200.00 100 100
121211851444 SEPONTOS JOSEPH ANTIVO 09/2019 200.00 100 100
121120307913 TITOY GEORGE ORTIZ 09/2019 200.00 100 100
105000971615 TOLIAO JOY UNGAO 09/2019 200.00 100 100
121204994931 VITTO ENRICO LAPIDES 09/2019 200.00 100 100

TOTAL FOR THIS PAGE

GRAND TOTAL (if last page)

4,000.00
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 DESIGNATION/POSITION DATE
(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

(V03, 10/2016)
 GUIDELINES AND INSTRUCTIONS
a. Type or print all entries in BLOCK or CAPITAL LETTERS. i. Failure or refusal of the Employer to pay or to remit the
b. Accomplish this form in softcopy when making remittances to Pag-IBIG Fund contributions herein prescribed shall not prejudice the right of the
or to any accredited collecting partner based on the following payment covered employee to the benefits under the Fund. Such Employer
schedule: shall be charged a penalty equivalent to 1/10 of 1% per day of
Schedule of Payments delay of the amount due starting on the first day immediately
First Letter of Due Date following the due date until the date of full settlement.
Employer/Business Name
A to D 10th to the 14th day of the month 1 Pag-IBIG Employer’s ID No. – assigned Pag-IBIG Employer’s ID
E to L 15th to the 19th day of the month Number.
M to Q 20th to the 24th day of the month
R to Z, Numeral 25th at the end of the month Employer/Business Name – per DTI/SEC Registration.
2
c. For employer with branch offices, please prepare separate Membership
Savings Remittance Form (MSRF) for each branch indicating therein their Employer/Business Address - indicate Unit/Room No., Floor,
respective addresses. 3 Building Name or Lot No., Block No., Phase No. or House No. and
d. A separate MSRF should be accomplished per type of payment (whether Street Name, Subdivision, Barangay, Municipality/City, Province,
cash or check payment) and in case Credit Memo shall be applied as and ZIP Code.
payment to the Fund. Pag-IBIG MID No. – indicate the member’s assigned Pag-IBIG
e. RATE OF MEMBERSHIP SAVINGS (MS) 4
Membership Identification (MID) Number.
MONTHLY COMPENSATION CONTRIBUTION RATE
(BASIC + COLA) EMPLOYEE EMPLOYER TOTAL Account No. – indicate the member’s assigned Account Number
5 per Membership Program.
P1,500.00 and below 1% 2% 3% NOTE: In accomplishing the Account Number column, for
Over P1,500.00 2% 2% 4% Pag-IBIG I contributions, indicate MID Number or RTN; for
Pag-IBIG II, indicate the assigned Account Number ; for MP2,
The maximum Monthly Compensation to be used in computing the employee indicate the system-generated Account Number provided after
and employer contribution shall not be more than 5,000.00. successful enrollment.
A member may contribute more than what is required, however the employer
shall only be mandated to contribute two percent (2%) of the monthly Membership Program – indicate if MS remittance is for Pag-IBIG
compensation of the member as counterpart contribution. In case the 6 I, Pag-IBIG II or Modified Pag-IBIG II program.
member increases his/her monthly membership savings, the employer shall Name of Members - indicate member’s complete name in the
have the option to match said increase or to contribute only what is required. following format: Last Name, First Name, Name Extension (Jr., III,
f. Membership contribution payments to be remitted should be equal to the total 7 etc.), Middle Name
amount reflected in the MSRF. Check payments should be made payable to
Pag-IBIG Fund and shall be posted upon clearing (clearing policy shall not be
applicable to National Government Agency (NGA), instead payment shall be Period Covered – indicate the applicable month and year of MS
posted within 72 hours upon receipt of collection). 8 remittance in the following format (YYYYMM).
g. Employers with over remittance from previous payments shall be issued with
a Notice of Overpayment and Credit Memo. For remittances previously made Monthly Compensation – refer to the basic salary and other
for employees for whom remittances should not have been made, the 9 allowances, where basic salary includes, but is not limited to, fees,
employer shall request a refund subject to the Fund’s verification and salaries, wages, and similar items received in a month. Accomplish
approval. The request shall be made not later than six (6) months from the this portion only when remitting the member’s initial membership
time said remittance was made. savings or if here are changes in monthly compensation of the
h. Employers who shall remit on or before the due date as evidenced by the member.
validated Membership Savings Remittance Form (MSRF) or Pag-IBIG Fund
Receipt shall be entitled to an incentive fee equivalent to 0.2% of the amount 10-12 Membership Savings – indicate the amount of employee
remitted provided he satisfy all the conditions required. contributions under column 10 the amount of employer
contributions under column 11 , and the total amount of employee
and employer contributions under 12 . Do not round off nor drop
centavos.
1 Remarks – accomplish this portion only to report changes in the
13 employee’s/member’s employment status and to update any
2 information regarding the employee/member. Indicate the
appropriate code and effectivity date in the following format
3
(mm/dd/yy) on the space provided for. Please refer to the following
codes and examples:
4 5 6 7 8 9 13
10 11 12

N - Newly Hired Examples

L - Leave Without Pay/AWOL 1. N: 1/4/2010
RS - Resigned/Separated 2. L: 1/21/2010
RT - Retired 3. RS: 1/3/2010
D - Deceased 4. D: 1/14/2010
O - Others, please specify reason

14 Indicate the total amount due and employer contributions per page.

Indicate the total amount due and employer contributions if this is

14
15
15 the last page.

Employer Certification - to be accomplished and duly signed by

16 16
the Head of Office/Authorized Representative.