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t_A$T t\AzuE fiRSr l"iAMr I.JAMI r-X-rf;.hr&](}t!i {'*"9r., .tr., /fi ir4lDDLE t{Alv1E MAIilEFi MINNLENA}J1E Pag-lBlG MID t',!o"
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ATTACH HERE
1'X1'ID PHOTO
cEv ffiTdPL$YMHNT STATU$ 3H$i,€ilAT'Qt'.t
DATE C}Is B}ftTII CELL PHONE NUMBER OF FUNO
I Mafe COORDINATOR
lf, Fenrate

PftT$ENT HOME ADDRESS E ltdAll AilSRESS /Reqidredj

Unii /Room Njr., Floor Buiiding Narne Lot No., Blo6k l'.Jc., Phase l.lo., llouse Nc. StrestNarie Subdivision

Baranga:y Municipal;tu Prov;noe,''Statelcounlr.l(if**a&) ZIP Ccde

lJ New fl Seplacem+nt

ErllPLSY ER,tsU$tilt[$$ Ah[]RE.$S BUS{NE$s/CELL PHONE NUMBER

r{O, SF EMFLGYEE$ ErdA[-

} ilNNER$TAHB THAT IF MY NOMII"IATION HAS BEEN A.PFRCVED BY Ti.IE F{Jll;D, IWILL AtrHERT TO THE POLICIE$ AND GUIDELINE$ fiF THE FAE.
,BIG FUND ANS SHALL PERFORfuI THE SUTIE$ AND RIPON$ItsILITITS AS A TilNt] COORSINATOH,

FURTHERMORE, I HEREBY CEftTIF}' THAT T}IE INFOR&1S?iOI'} *}VEF,,I AI'ID ALL STATEMENT$ MADE HEREIN ARE TRUE AND CORRECT

RJND CSORDjI'.]ATOR Di;$rsN*Ti{}'!F$SrTipN

a,iet Ptiarc{i

I HERESY NOIIINATE AJ\l{} DEslSf']ATE THE AFGREMENTIONED EMpLOYfg A$ OUR FUNE COORS${ATOE TO Pag-}BlG FUND. FURTH€.R, I
CHRTIFY THAT TI{E IhIFORMATION G'VEN AND ALL S:I,\TEMEhTTS MADE HEREIN ARE TRUE A}iil CORftECT.

Hf;AD OF OFFICE OR AU]}{ORIZEil $IGNATCRY ilH$ lGNATl(]N,POS !TlOl'l {.iATE

FOR Fag-i6iG i:i,,i{E {J$H SSiLY

FJH$[}VF,D BY DA-TH $tHh4ARl($

APFTEOVr fi /'DISAFP& *!/il[i BY HEL{ARKS

EHECKLIS? {iT ffi fr QUIRH&'IENT$

1, Fund Coordinator No,Trination Form iFCNF, HAP"PFF.$64 (2 coBies) 3. Compiilny l* and i Valid ID #srd with photo and signature ol Fund Ccrrdinator
2. Two {2} latest 1x1 tD Fhot* [Hefer to Liet of
yalid lDs ,q{:ceptable to the Fund {HAF-PFF-225)|
4. Fhot*ropy of 2 Valid lD Oatdr of l-{ead of Office or Authorieed Sigfiatory

A. For t*letr/Ren*wal B. Fon fteplacement

Letler of En<iorsement duly $i$n6d by th* H--ad af $ffice cr *uthorieed Letter for Replac+m*nt of Fund Ssordinator
$ignatory

N*TE: tn case of cftanges in Fund Cmrdv:a{or's infoffiatiott, sach as tr\I*re *r Oesl6rnalian, tka Fund Coordnafor sfuaJJ 5s requked fu sabmiUpresent suppling
c&**rment/s as proo/of changes ra l+t'vher !fi{o?#elfl.r} to PW4B|G Fund $ra*ch nainiaining the rccord"
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HAP.PFF.ffi7
(dil2. CI512018)

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I, QUALIFEATIONS
The nominee tor Fund Coordinator muet:
, Be a regular employee of the c-ompany with sufficient discretion, preterably from the Human Resource Department or Accounting Department;
'. Be capable of imparling information to co-employeee;
Be of known probity;
* $e an active Pag-l8tG Fund member under the mrnpany dtre represent and if with existing Short-Term Loan {STL), the account nnrst be updated; and
. Have an active official company ernail account.

II. FIOWTO NOMINATE

The Employer or its Authorized Representative shall:
1. Secure a Fund Coordinator Nomination Form (FCNF, HOP-PFF-067) fron Pag-lBlG Fund Branch or may download,frorn Pag-lBlG Fund website at
www.pagibigf und.g0Y. ph.
?. Submit duly accomplished FCNF (2 copiesi together with reguired supporting documents to Pag-lBlG Fund Branch.
III" NIJMSER GF FUNO GOGftDIHATOE.
The employer or its &utl'rorized Represefitetive n'!ay designate up to three (3) Fund Coordinatoro based sn the following:

Number of Ernployees Number of Fund

Coordinator
More than 50 employees ta 2,700 eftployees l
More than 2,750 employee$ ts S,10t] entploy**e 2
More than S,100 *mpl0y*es ?

IV. UUT}IS AND RESPOITISIBILITIE$

The designated Fund Coordifiator shall:
1. Att as the official represe ntative of the ccmpany in its official transactian of its organiaation with the Fund namely;
a.Pr*-Eerees thek e.mployeea sh€{t-term l6en {SfL} €ppkeation+ relaiive io Soncwsr's oligibiiity stated ifi the pre\&i}in$ STL prosrat"n.
b. Confirm ETL on-lifle application$.
c.Represent cr receive coresponcling checks *n behalf of hisher employer/co-employee provided s/he posse*ses a ,$pecial power of ,{torney
($PA) fronl the employee concern*rl together with two {2} valid government issued identilicalion +ards.
d.Facilitate submission of $pecimen $ignature Ntorm ($$[.
2. Hnsure that their employees have MIO/RTIII prior to subrnissior cf Hemittance List ot their employ*es t* the Fund.
3. $erve as an offioial link between the Fund and employee-members about the Fllild'$ Frogram anel activitles.
4. Facilitate pa*icipation of employer In PagJBlG Fund programs, such as but not limited to Loyalty Card, Electronic Fay:nent and Colleciion Facility
(EPCf), Electronic $ubmission of Rernittance $chedule iESRSi and similar faciiities.
5. Attend afi meelingslferums/assernblies called by the Fund.
V, MOSE *F !$SUAI{CS OF FCIC
The Firnd Csordinat*r ldeniification Card {FCIC, i"IAP-PFF-068} sha}l be issued through any of the folloring n'lodee:
a. Pi.kupat{hebrar$h
b. Registered mail
c. 0ther modes of distribution
VI. VALfDITY SF TGffi
The FCIC shall he vaiid for the period of one {1) year fronr the date of approvai of tl're nomination }orm.

VII, REPLACEMHHT OF FErc

For jost FCIC, the Fund Cocrdinator shall subrnit the following dscuments to Pag-lBiG Fund Bran*h;
. Suly Notmized Affidatrit *f L66s
". Lefter Request
2 [atast 1xl lD photo

vlti, *"r"ht*s.$

a. The authoriz*d $om,]any representatlve shall give the FC futl authority to transact with the Fund.
b. Renewai sf FC shall be done on a yearly basis. hlon-submission cf docurnent requirement shali not warrant to an automatic r*nerJel of FC.
c. The FC rnay bs sub$tituted anytime upon diseretion of the authorized company represent€tive. ln case of separation from eniployer sf the FC, the
efilployer shail autoffinticeliy*+n'rinefe a subetlt#e FC with earrespo*ding noticre to the Fund.
d. An additisnal or aitremate FC may he ailowed in ca$e the existing FS i+ on ,eave or fsr those with rnultipie eompani€s $r $lster cornpanier, with written
notice ta the Fund. Nomination form shall also be filled cut for the additional or alternate FC.
e. The Fund shall not be held liahle for any unauthoriz*d transactians made by the FC irr case of hisilter employer's failure fo rep*rt the cl'rarrge of FC.