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EBCS Enrollment Form Rev

This document is an enrollment form for the eBCS system. It collects contact and identification information for a remitting agency officer or finance officer, including their name, office details, contact information, and mother's maiden name. The form requires signatures from the requesting officer and an indorsing officer to authorize access. Notes at the bottom specify that all boxes must be filled out except for termination requests and that authorizations remain valid until GSIS receives a termination request.

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Reymond Lovendino
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5K views

EBCS Enrollment Form Rev

This document is an enrollment form for the eBCS system. It collects contact and identification information for a remitting agency officer or finance officer, including their name, office details, contact information, and mother's maiden name. The form requires signatures from the requesting officer and an indorsing officer to authorize access. Notes at the bottom specify that all boxes must be filled out except for termination requests and that authorizations remain valid until GSIS receives a termination request.

Uploaded by

Reymond Lovendino
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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eBCS ENROLLMENT FORM

(revised)

Finance Officer Data Sheet


Remitting Agency Officer Data Sheet

New5
Termination

Office Name
Agency BP No
Office Address
GSIS Old ID No./BP No.
Last Name
First Name
Middle Name
Remitting Agency Officer/Finance Officer Contact Details
Cell Phone Number:
Office Telfax1 Number
with Area Code
Office Telfax2 Number
with Area Code
Email Address
Remitting Agency Officer/Finance Officer Mothers Maiden Name Information
Mothers Maiden Last Name
Mothers First Name
Mothers Maiden Middle Name
Signatures of Requesting Agency Officers
Remitting Agency Officer/Finance Officer:
_________________________
Signature over Printed Name
Indorsing Officer:
________________________
Signature over Printed Name

________________
Designation/Position

________________
Date Accomplished

_____________________
Designation/Position

________________
Date Accomplished

We understand that by affixing our signatures on the above, authorization when granted, is specific
to the office specified in this application form. Moreover, it will be disabled after GSIS received
request for termination.
Please Do Not Fill-Up. For GSIS Use Only
Reviewed by GSIS Accounts Management Staff
Approved by GSIS Department Manager/Branch Manager
Action Taken
Authorization Enabled

Date Accomplished
Initial & Date

Authorization Disabled

Notes:
1. All boxes MUST be filled up (Type or Print) except signature/designation portion of the
authorized officer for TERMINATION
2. Authorizations are valid until request for termination is received by the GSIS

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