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eSRS Reg Form PDF

This document is an employer enrollment form submitted to Pag-IBIG Fund. It provides details about Carillon Mercantile Corp. including their employer ID number, business name, address in Quezon City, Philippines, and contact information for their authorized user, Ma. Arlene A. Bautista. The form certifies that the provided information is true and designates Ariel G. Bautista as the authorized signatory approving the enrollment on behalf of the employer.

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Darlyn Etang
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2K views

eSRS Reg Form PDF

This document is an employer enrollment form submitted to Pag-IBIG Fund. It provides details about Carillon Mercantile Corp. including their employer ID number, business name, address in Quezon City, Philippines, and contact information for their authorized user, Ma. Arlene A. Bautista. The form certifies that the provided information is true and designates Ariel G. Bautista as the authorized signatory approving the enrollment on behalf of the employer.

Uploaded by

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

(V04, 07/2018)

eSRS EMPLOYER ENROLLMENT FORM

Employer ID Number : 202211490002


Employer/Business Name : CARILLON MERCANTILE CORP.
Pag-IBIG Servicing Branch : COMMONWEALTH BRANCH
Employer Type (i.e., Private or Government) : PRIVATE

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
25 MC KINLEY ST.
Business (Trunk Line) Local
Subdivision Barangay
DON ANTONIO ROYALE ESTATE
Cell Phone
Municipality/City Province
09177486281
QUEZON CITY METRO MANILA
Region Zip Code Business Email Address
NCR arlenebautista168@gmail.com

AUTHORIZED USER DETAILS


Pag-IBIG MID Number : 121198880798 User Name : CARILLONMERCANTILE
Name : MA. ARLENE A. BAUTISTA Email Address : arlenebautista168@gmail.com
Designation : CORP. TREASURER Cell Phone Number : 09177486281

EMPLOYER’S CERTIFICATION

We certify that the information herein stated is true and correct; that we shall be responsible for 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.

ARIEL G. BAUTISTA
____________________________ PRESIDENT
______________________________ 08/27/2020
_______________
Authorized Signatory Designation Date
(Signature Over Printed Name)

FOR Pag-IBIG Fund USE ONLY

Approved by:

____________________________ ______________________________ _______________


Authorized Signatory Position/Designation Date
(Signature Over Printed Name)

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