BANGKO SENTRAL NG PILIPINAS

CABANATAUN
R BRANCH
e
DATE: p
AGENCY INFORMATION
u SHEET
b
NAME OF AGENCY l:
ADDRESS i:
AGENCY BUSINESS PARTNER NUMBER k:
E-mail Address a:
Contact Numbers :
n
Specimen Signatures: g

A. Head of Agency P Assistant to the Head of Agency (if applicable)

Person in-charge i Person in-charge
Position Title l Position Title
Telephone Number i Telephone Number
p
Fax Number Fax Number
i
E-Mail Address n E-Mail Address
Specimen Signature a Specimen Signature
s
Specimen Initial P Specimen Initial
A
B. Agency Remittance Advice S Agency Remittance Advice
Person in-charge E Person in-charge
Position Title G Position Title
U
Telephone Number Telephone Number
R
Fax Number U Fax Number
E-Mail Address H E-Mail Address
A
Specimen Signature N Specimen Signature

C. Disbursing Officer N Budget Officer

Person in-charge G Person in-charge
Position Title Position Title
M
Telephone Number G Telephone Number
Fax Number A Fax Number
E-Mail Address E-Mail Address
N
Specimen Signature A Specimen Signature
G
L
D. Service Record Service Record
I
Person in-charge L Person in-charge
Position Title I Position Title
Telephone Number N Telephone Number
Fax Number G Fax Number
E-Mail Address K E-Mail Address
O
Specimen Signature D Specimen Signature

S
E. Remittance Lists/Secondary Evidence ( Payroll, Payslip, Subsidiary
A Ledger and Others)
Person in-charge Person in-charge
Position Title P Position Title
Telephone Number A Telephone Number
Fax Number M Fax Number
A
E-Mail Address H E-Mail Address
Specimen Signature A Specimen Signature
L
Specimen Initial A Specimen Initial
A
N
F. Retirement/CSV/TV/Maturity/Survivorship/EC ( Authorized Indorsing Officer
G
Applications and other claims O
Head of Agency V Person in-charge
Position Title E Position Title
Telephone Number R Telephone Number
N
Fax Number Fax Number
M
E-Mail Address E E-Mail Address
N
Specimen Signature T Specimen Signature

Specimen Initial S Specimen Initial

E
G. Liaison Officer 1 R Liaison Officer 2
Person in-charge V Person in-charge
I
Position Title Position Title
C
Telephone Number E Telephone Number
Fax Number Fax Number
E-Mail Address I E-Mail Address
N
Specimen Signature S Specimen Signature
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I
N
Specimen Signature S Specimen Signature
U
Specimen Initial R Specimen Initial
A
N
H. Agency Authorized Officer (AAO) C Alternate Agency Authorized Officer (AAO)
Person in-charge E Person in-charge
Position Title Position Title
Telephone Number S Telephone Number
Y
Fax Number Fax Number
S
E-Mail Address T E-Mail Address
E
Specimen Signature M Specimen Signature
Specimen Initial ) Specimen Initial
C
A
I. Employee Responsible for Electronic Billing File V Alternate Employee Responsible for Electronic Billing File
I
Person in-charge Person in-charge
T
Position Title E Position Title
Department Department
Telephone Number D Telephone Number
E-Mail Address I E-Mail Address
S
J. Employee Responsible for Electronic Remittance File T Alternate Employee Responsible for Electronic Remittance
R
File
I
Person in-charge C Person in-charge
Position Title T Position Title
Department Department
Telephone Number O Telephone Number
E-Mail Address F E-Mail Address
F
I
K. Employee Responsible for Reconciliation Billing Issues C Alternate Employee Responsible for Reconciliation Billing
E Issues
Person in-charge 2 Person in-charge
Position Title n Position Title
Department d Department
Telephone Number Telephone Number
F
E-Mail Address l E-Mail Address
o
L. Payroll Deduction (Weekly Notice to Deduct) o Payroll Deduction - Alternate to Receive WNTD
Person in-charge r Person in-charge
Position Title Position Title
Department S Department
t
Telephone Number . Telephone Number
E-Mail Address E-Mail Address
V
M. eBCS Remitting Agency Officer/eBCS Handler i eBCS Finance Officer
Person in-charge n Person in-charge
Position Title c Position Title
e
Department n Department
Telephone Number t Telephone Number
E-Mail Address E-Mail Address
H
N. Head of Employees Union a Human Resources Officer
Person in-charge r Person in-charge
d
Position Title w Position Title
Department a Department
Telephone Number r Telephone Number
E-Mail Address e E-Mail Address
,

Certified Correct: M
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________________________________________
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PRINTED NAME & SIGNATURE OF AGENCY HEAD g
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