Pagibig - Form

Pag-IBIG Fund
MEMBERSHIP REGISTRATION/REMITTANCE FORM

PRIVATE EMPLOYER LOCAL GOVERNMENT UNIT NAME OF EMPLOYER FOR PRIVATE EMPLOYER ADDRESS OF EMPLOYER TIN ZIP CODE GOVERNMENT CONTROLLED CORP. NATIONAL GOVERNMENT AGENCY
(Please read instructions at the back)
M1-1
YEAR
MONTH
EMPLOYER SSS NO. FOR GOVT EMPLOYER
AGENCY BRANCH REGION CODE CODE CODE
TELEPHONE NO/S.
TIN
NAME OF EMPLOYEES DATE OF BIRTH (Family Name 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. First Name Middle Name) EMPLOYEE
CONTRIBUTIONS EMPLOYER TOTAL
No. of Employees on this page
Total No.of Employees if last page
TOTAL FOR THIS PAGE GRAND TOTAL (if last page)
P P
P P
P P
FOR Pag-IBIG USE ONLY

PFR/VALIDATION No. COLLECTING BANK TICKET DATE MM DD RECONCILED BY DATE MM DD YY AMOUNT P REMARKS CHECKED BY
CERTIFIED CORRECT BY: SIGNATURE OVER PRINTED NAME OFFICIAL DESIGNATION DATE
PAGE NO. NO. OF PAGES
YY
NOTE: NEW REGISTRANTS SHALL PROVIDE TIN AND DATE OF BIRTH
(Revised 05/2003)
THIS FORM CAN BE REPRODUCED. NOT FOR SALE
HOW TO ACCOMPLISH THIS FORM

a. Please type or print all entries. b. Prepare this form in two (2) copies [three (3) copies for national government employers] every end of each calendar month when making remittances to Pag-IBIG Fund or to any collecting agent Schedule of Payments First letter of Employers/Company Name A to D E to L M to Q R to Z Due Date 10th to the 14th day of the month 15th to the 19th day of the month 20th to the 24th day of the month 25th to the end of the month d. For national government agencies, indicate the employee and employer contributions in the report but remit only the employees share. The employers share will be to the Department of Budget and Management. For local government and controlled corporations, remit employees share together with employers counterpart e. Non-payment of contributions shall subject the employer to a three percent (3%) penalty per month of the amount payable from the date the contributions fall due until paid (Sec. 22 of PD 1752) *EEs - Employees share **ERs - Employers share *** The employer may match his employees contributions based on their higher MC If the employer provides only the mandatory counterpart, which is up to P100.00, the employee has the option to shoulder the ER counterpart for the portion of his MC over P5,000.00
c. For employer with branch offices, please prepare separate Membership Registration/Remittance Form (MRRF) for each branch indicating therein their respective addresses. Take note that the maximum Monthly Compensation (MC) of Pag-IBIG I employee-members is P5,000.00. However, those with MC over P5,000.00 may declare their actual salary levels for computing their monthly Pag-IBIG contribution. For purposes of computing the Employees/Employers contribution, please be guided by the following. MONTHLY COMPENSATION (BASIC + COLA) EEs*
1 2 3 4
Put an X mark to indicate employer classification. When making remittances to Pag-IBIG Fund, indicate the applicable month and year of contribution. Print name of the employer. For private employers, indicate your Employer SSS ID No. For government employers, indicate your Agency, Branch and Region Codes. Print the full address of the employer. For employer with branch offices, please prepare separate MRRF for each branch indicating therein their respective addresses.
ERs**
TOTAL
Up to P1,500.00 P1,501.00-P5,000.00 Over P5,000.00
1% 2% 2% of MC
2% 3% 2% 4% 2% of P5,000.00***
Pag-IBIG Fund
5 6
M1-1
YEAR
MEMBERSHIP REGISTRATION/REMITTANCE FORM

1
PRIVATE EMPLOYER LOCAL GOVERNMENT UNIT
GOVERNMENT CONTROLLED CORP. NATIONAL GOVERNMENT AGENCY

MONTH
(Please read instructions at the back)

NAME OF EMPLOYER
3
FOR PRIVATE EMPLOYER
2
FOR GOVT EMPLOYER AGENCY CODE BRANCH CODE REGION CODE
EMPLOYER SSS NO. 4
7 8
Indicate employers Tax Identification No. (TIN) Indicate the zip code. Indicate the telephone number/s of the employer. Indicate the correct Tax Identification No. (TIN) of your employees to ensure the contributions are credited to their respective accounts. Indicate employees birth date in numeric format. Example March 20, 1956, shall be written as 03/20/56. List the name of your employees. This may be for the purpose of registering your employees for Pag-IBIG membership or for remitting contributions. Indicate the amount of employee contributions. Do not round off nor drop centavos. Indicate the amount of employer counterpart contributions. Do not round off nor drop centavos. Indicate the total amount of employee and employer contributions. Indicate the number of employees listed in this page. Indicate the total number of employees listed if this is the last page of the listing. Indicate the total amount of employee contributions (under column 13 ), the total amount of employer contributions (under column 14 ) and the total amount of employee and employer contributions (under column 15 ) for this page. Indicate the grand total of employee contributions (under column 13 ), the grand total of employer contributions (under column 14 ) and the grand total of employee and employer contributions (under column 15 ) if this is the last page. Indicate the number of this page. Indicate the total number of pages of this listing.
ADDRESS OF EMPLOYER
6
TIN
7
ZIP CODE
8
TELEPHONE NO/S.
9
TIN
DATE OF BIRTH (Family Name 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39.
NAME OF EMPLOYEES First Name

12
CONTRIBUTIONS Middle Name) EMPLOYEE

13
EMPLOYER
14
TOTAL
15
10
11
9 10 11 12 13 14 15 16 17 18
19
TOTAL FOR THIS PAGE GRAND TOTAL (if last page) AMOUNT
No. of Employees on this page
16
40. Total No. of Employees if last page
17
18 19
P P
P P
CERTIFIED CORRECT BY:
P P
DATE
PAGE NO. NO. OF PAGES
FOR Pag-IBIG USE ONLY PFR/VALIDATION No. COLLECTING BANK TICKET DATE MM DD YY RECONCILED BY DATE MM DD YY
P
REMARKS CHECKED BY SIGNATURE OVER PRINTED NAME OFFICIAL DESIGNATION
20
21
20
NOTE: NEW REGISTRANTS SHALL PROVIDE TIN AND DATE OF BIRTH
21
THIS FORM CAN BE REPRODUCED. NOT FOR SALE

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Pag-IBIG Fund

MEMBERSHIP REGISTRATION/REMITTANCE FORM

EMPLOYER SSS NO. FOR GOVT EMPLOYER

AGENCY BRANCH REGION CODE CODE CODE

CONTRIBUTIONS EMPLOYER TOTAL

No. of Employees on this page

Total No.of Employees if last page

TOTAL FOR THIS PAGE GRAND TOTAL (if last page)

FOR Pag-IBIG USE ONLY

NOTE: NEW REGISTRANTS SHALL PROVIDE TIN AND DATE OF BIRTH

THIS FORM CAN BE REPRODUCED. NOT FOR SALE

HOW TO ACCOMPLISH THIS FORM

Up to P1,500.00 P1,501.00-P5,000.00 Over P5,000.00

MEMBERSHIP REGISTRATION/REMITTANCE FORM

PRIVATE EMPLOYER LOCAL GOVERNMENT UNIT

GOVERNMENT CONTROLLED CORP. NATIONAL GOVERNMENT AGENCY

(Please read instructions at the back)

EMPLOYER SSS NO. 4

NAME OF EMPLOYEES First Name

CONTRIBUTIONS Middle Name) EMPLOYEE

No. of Employees on this page

40. Total No. of Employees if last page

NOTE: NEW REGISTRANTS SHALL PROVIDE TIN AND DATE OF BIRTH

THIS FORM CAN BE REPRODUCED. NOT FOR SALE

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