HQP-PFF-002
(V09, 12/2022)
FOR Pag-IBIG Fund USE ONLY
EMPLOYER’S DATA Pag-IBIG EMPLOYER ID NO.
FORM (EDF) REGISTRATION TRACKING NO.
INSTRUCTIONS
1. Accomplish this form in one (1) copy.
2. Type or print all entries in BLOCK or CAPITAL LETTERS.
3. On the "CONTACT DETAILS" portion, indicate available contact information.
4. All fields which are marked with asterisk (*) are mandatory.
5. On the “INDUSTRY” portion, indicate industry based on the List of Industry at the back of the form.
6. Submit duly accomplished form and present required supporting documents based on the Checklist of Requirements found at the back of the form.
*EMPLOYER/BUSINESS NAME
JBDELECTRICAL AND CONSTRUCTION SERVICES
ADDRESS AND CONTACT DETAILS
*EMPLOYER/BUSINESS ADDRESS AREA CODE TELEPHONE NUMBER
Unit/Room No., Floor Building Name
Business (Direct Line)
Lot No., Block No., Phase No. House No Street Name
4237 ST. PETER STREET, Business (Fax)
Subdivision Barangay
ST. SPS 1, SUBDIVISION, ROSARIO, Business (Trunk Line) Local
Municipality/City
PASIG CITY *Cell Phone
0995-359-2620
Province ZIP Code
1609 Business Email Address
[email protected]
EMPLOYER/BUSINESS DETAILS
START OF BUSINESS OPERATION DTI/SEC/CDA REGISTRATION DATE OF *INDUSTRY
0 2 0 5 2 0 2 5 CERTIFICATE No. ISSUANCE
m m d d y y y y 6878126 02/05/2025 CONSTRUCTION
*BRANCH/OFFICE *TYPE OF EMPLOYER *BUSINESS TAXPAYER IDENTIFICATION
Head Office X
Private NUMBER (TIN)
Branch (Please Specify) ____________ Government 230-051-850-000
For Private Employers For Private Employers
*LEGAL PERSONALITY SSS Employer Number
XSole Proprietorship
Cooperative/Trade Association 80-0403237-7-000
Partnership Foreign-owned Corporation Date of Registration
Corporation 0 3 0 3 2 0 2 5
m m d d y y y y
For Government Employers
*CLASSIFICATION For Government Employers
National Government Government-Owned and Controlled Corporation GSIS Business Number
Local Government Unit (LGU) (GOCC)/Government Financial Institution (GFI)
Constitutional Office Agency/Branch/Division Code
CERTIFICATION
I hereby certify that the information given, and all statements made herein are true and correct. Likewise, I hereby authorize Pag-IBIG Fund to
collect record, organize, update/modify, consult, use, consolidate, block, erase or destruct company’s personal data as part of its information. I
hereby affirm my right to: (a) be informed; (b) object to processing; (c) access; (d) rectify, suspend or withdraw our company’s personal data; (e)
damages; and (f) data portability pursuant to the provision of R.A. No.10173 (Data Privacy Act of 2012).
JO RG E BOGNALOS DOGILLO III
________________________________________ PROPRIETOR
____________________________ MARCH 0 4, 202 5
____________________
*Head of Office/Authorized Signatory *Designation/Position Date
(Signature over Printed Name)
FOR Pag-IBIG FUND USE ONLY
RECEIVED BY:
(SIGNATURE OVER PRINTED NAME) _____________________________ _____________________
(POSITION/DESIGNATION) BRANCH/UNIT DATE AND TIME
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.
HQP-TMF-190
(V06, 02/2024)
Pag-IBIG Fund
eSRS EMPLOYER ENROLLMENT FORM
Employer ID Number :
Employer/Business Name : JBDELECTRICAL AND CONSTRUCTION SERVICES
Pag-IBIG Servicing Branch :
Pag-IBIG Branch Code :
Employer Type (e.g., Private or Government) : PRIVATE
ADDRESS AND CONTACT DETAILS
EMPLOYER/BUSINESS ADDRESS AREA CODE TELEPHONE NUMBER
Unit/Room No., Floor Building Name
Business (Direct Line)
Lot No., Block No., Phase No. House No. Street Name
4237 ST. PETER STREET, Business (Fax)
Subdivision Barangay
ST. SPS 1, SUBDIVISION, ROSARIO, Business (Trunk Line) Local
Municipality/City
PASIG CITY Cell Phone
0995-359-2620
Province ZIP Code
Business Email Address
1609
[email protected]
AUTHORIZED USER DETAILS
Pag-IBIG MID Number: User Name : jbd_electrical2025
Name : Jorge Bognalos Dogillo III Email Address :
[email protected] Designation : Proprietor Cell Phone Number : 0995-359-2620
EMPLOYER’S CERTIFICATION
We hereby certify that the information given, and all statements made herein are 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.
Likewise, we hereby authorize Pag-IBIG Fund to collect, record, organize, update/modify, use, consolidate,
block, erase or destruct the personal data as part of our information. We hereby affirm our rights to: (a) be informed;
(b) object to processing; (c) access; (d) rectify, suspend or withdraw our personal data; (e) damages; and (f) data
portability pursuant to the provision of R.A. No. 10173 (Data Privacy Act of 2012).
JORGE BOGNALOS DOGILLO III PROPRIETOR March 04, 2025
___Signature Over Printed Name___ ___(Position/Designation)___ ______(Date)_____
Authorized Signatory
FOR Pag-IBIG FUND USE ONLY
Approved by:
___(Signature Over Printed Name)___ _____(Branch/Unit)_______ _____(Date)_____
(Position/Designation)
X
JBDELECTRICAL AND CONSTRUCTION SERVICES 4237 ST. PETER STREET, ST. SPS 1, SUBDIVISION, ROSARIO, PASIG CITY
DOGILLO, JORGE III BOGNALOS DOGILLO, ELVIRA LOPINA DOGILLO, JORGE III BOGNALOS
PROPRIETOR SECRETARY PROPRIETOR
DOGILLO, JORGE III BOGNALOS PROPRIETOR March 04, 2025
