HQP-SLF-017

SHORT-TERM LOAN Pag-IBIG EMPLOYER'S ID NUMBER

8001-7058-1494
REMITTANCE FORM (STLRF)
NOTE: PLEASE READ INSTRUCTIONS AT THE BACK.
EMPLOYER/BUSINESS NAME
FAR EAST MARITIME ACADEMY AND TECHNOLOGICAL CORPORATION

EMPLOYER/BUSINESS ADDRESS PERIOD COVERED

Unit/Room No.,Floor Building Name Lot No., Bock No., Phase No., House No. Street Name MARCH, 2018

Subdivision Barangay Municipality/City Province/State/Country (if abroad) ZIP Code TELEPHONE NUMBER
CAYANGA SAN FABIAN PANGASINAN 09491052402
APPLICATION/ NAME OF BORROWER EMPLOYER
MID No. LOAN TYPE AMOUNT
AGREEMENT No. Last Name First Name Name Ext.(Jr.,III,etc.) Middle name REMARKS
1211-0436-6211 CARRERA ROSELROMULO PEREZ MP3 634.40 15th Payment

TOTAL FOR THIS PAGE PHP 634.40

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
certity that my signature appering herein is genuine and authentic.

JAIME B. MANAOIS ACCOUNTANT April 09, 2018

HEAD OF OFFICE OR AUTHORIZED SIGNATORY DESIGNATION/POSITION DATE

(Signature Over Printed Name)

THIS FORM MAY BE REPRODUCED. NOT FOR SALE. Rev. 00, 02/2013
Compatibility Report for LOAN FORMAT.xls
Run on 2/13/2017 9:57

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