Orientation Checklist

NAME:P POSITION: P

PROGRAM:P DATE: P

TOPICS DISCUSSED DURING NHO

Mission Gallup

Vision Ask Allen

Corporate Values / Platinum Awards Kronoz Timekeeping

History PeopleSoft

Organization Use of email

Corporate Set-up / Officers Use of Internet

Important Office Rules Security Policy

Code of Conduct GTI Policy

Payroll InfoSec Policy

Performance Management / Goals Employee Engagement Activities

Execution Excellence Office Lay-out

Benefits SD Welcome Speech

Orientation date and venue: P

I acknowledge that I was oriented regarding the above topics marked with . I further acknowledge
that I understood all its contents and agree to uphold the company's interest at all times by following its
rules and regulations.

P_______________________________________________________
EMPLOYEE'S SIGNATURE OVER PRINTED NAME
 STATEMENT OF UNDERSTANDING
Information Security and Privacy Awareness

I, _______________________________ (Name), certify that I have participated on the

INFORMATION SECURITY AND PRIVACY AWARENESS TRAINING which was conducted on

_______________. I have had the opportunity to ask questions about the company’s

information security policies, procedures and practices. I acknowledge that I fully understand

what my responsibilities are and what the impacts of not complying with information security

policies are. I agree to and will comply with the information security policies and procedures, and

other guidelines set forth in the employee handbook. I understand that the company reserves the

right to change, modify, or abolish any or all of the policies, rules, and regulations contained or

described in the information security policy as it deems appropriate at any time, with or without

notice.

________________________________
Employee Signature over Printed Name

_____________________
Date Signed

Noted By:

________________________________________________________________
Internal Use Only
 EMPLOYEE NO.____________

RELEASE, WAIVER AND QUIT CLAIM

I ______________________________, of legal age and with postal address at

___________________________________________, after having been sworn to in accordance with law, do hereby
depose and state that, to wit:

1. I am a new employee of Sutherland Global services Philippines, a branch of Sutherland Global Services, with
office address in the Philippines at Philplans Corporate center, Triangle Drive Bonifacio Global City Taguig
Metro Manila Philippines.
2. I am fully aware of my obligation to submit my current year’s W-2 BIR Form No.2316 from my previous
employer to Sutherland as part of my pre-employment requirements.
3. I am also aware that my deadline for the submission of my current years W-2 BIR Form No.2316 from my
previous employer to Sutherland is on or before ____________________ of the current taxable year consistent
with the preparation of Sutherland for the year-end tax computation.
4. Failure to submit my current year’s W-2 BIR Form No.2316 from my previous employer relieves Sutherland from
any obligation to file any withholding tax payable in behalf. Thereafter Sutherland shall proceed computing
my year-end tax based on their records and should there be any withholding tax payable to the government, I will
personally file settle and pay it with the Bureau of Internal Revenue (BIR) or any of their registered collection
agencies.
5. Despite full knowledge my obligations, I have failed to submit and present my current year’s W-2 BIR Form
No.2316 from my previous employer to Sutherland.
6. In consideration of the foregoing, I have forever released, remised and discharge, for myself, my
representatives, agents, heirs, executors and administrators, hereby remise, released and forever discharge
Sutherland Global Services, its successors, assigns, and trustees and/or directors, officers, stockholders,
employees, and representatives, from any action or actions, cause or causes of action, sum of money,
accounts, damages, claims and demands whatsoever in law or in equity, I ever had, now have, or hereafter may
have, or which my representatives, agents, assigns, heirs, executors and administrators can, shall or may have
upon and by reason of my failure to submit the BIR document to Sutherland.
7. I also hold Sutherland free and harmless from any claim, liability, penalty and/or compensation that may arise as
a result of my failure to submit the above mentioned BIR document.
8. I confirm that I read and understood the contents of this Receipt, Release and Quitclaim and that I voluntary
signed the same.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at Taguig City.

________________________
Affiant / Employee Signature

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

Taguig City) S. S.
Subscribed and sworn to before me this___________by MR./MS.___________, who exhibited to me his
Residence Certificate No. __________issued on______at______.

NOTARY PUBLIC

Doc No._________
Page No._________
Book No.________
Series of_________
 Non-Disclosure Agreement
I, the undersigned, acknowledge and agree that after going to the process
of orientation do hereby state :

1) All Information obtained from or on behalf of Sutherland Global

Services Inc., or its subsidiaries or affiliates shall be considered
"Confidential Information".

2) That I, under the terms and condition of my company service

contract with Sutherland Global Services shall withhold in the
strictest confidence and will not disclose any confidential
information as stated in paragraph 3 of this acknowledgement during
my deployment and service to Sutherland Global Services.

3) Confidential Information.

i. Names and addresses of Sutherland Global

Services executive and managemen t people

ii. Information and process relating to its:

1. Business Operations

2. Business and Security processes.

3. Vendors and contractors names and addresses.

4. Incidence and events.

_P__________________________________
(Signature)
_P____________________________________
(Printed Name)
_P__________________________________
(Address)
_P__________________________________ Noted by:
(Date)
 COMMITMENT TO ATTENDANCE AND PUNCTUALITY FOR
PROBATIONARY EMPLOYEES
Consistent with your employment contract, you will be on probationary status for no more than one hundred eighty
(180) days from the start of your employment. During this period, the Company will evaluate your performance, among
others, in terms of your dependability, efficiency, initiative, attitude (as regards our customers, the Company and its
officers and your colleagues), cooperation, client response, judgment, punctuality, quality and quantity of work, and
professionalism.

By a copy of this document, you hereby agree and commit to strictly observe shift schedule, `training schedule,
workdays, work hours and break periods. You must be able to report to work regularly and on time. Frequent
absences, tardiness or “undertime” is strictly forbidden.

The following attendance guidelines will be followed during your probationary period:

1. The company requires the full 180 day period to measure the fitness and qualification of an employee for
permanent and regular employment.
a. Hence, probationary employees will be allowed a total of 4 absences (regardless of reason) during
the entire 180 day probationary period.
b. However, given the importance of training, in no case will an employee be allowed more than 2
absences (regardless of reason) while in training. In cases where the training is more than 2 months,
employee will be allowed 3 absences (regardless of reason).

2. All absences during training will form part of the employee’s attendance during the whole probationary
period. Hence, employees with perfect attendance in training will have allowable absences up to the total (4
days) while on the floor during the rest of their probationary period. Any excessive absence following this
provision shall lead to non-regularization.

3. Exceptions will be managed between Sr./HR Director and Sr./Training Director (which can include prolonged
sickness or injury or valid family emergency, all with supporting documentation). In such a case, employee
must notify his/her trainer or the immediate manager to advise a valid sick or emergency leave. Otherwise,
employee may be sanctioned for NO-CALL, NO SHOW, as follows:

1st instance – Final Written Warning

2nd instance - Termination via non-regularization

4. Where an employee failed to present medical records or proof of emergency within 3 days after the supposed
emergency, the employee may be sanctioned for unauthorized absence, sanctioned similarly as No Call, No
Show.

5. Absences will have no rolling period. Refresh will happen once they are regularized since employees will then
have leaves and will be covered by the absences policy following the handbook.

6. In cases of Tardiness, employee will be allowed a total of 5 instances/occurrence of tardiness during the entire
probationary period. Exceeding this number will result to non-regularization.

7. Non-compliance in any of these provisions shall be a valid ground to terminate the probationary period of an
employee for failure to meet the required standards of behavior and performance, consistent with the
provisions of his employment contract.

Acknowledgement and Acceptance Clause

I hereby acknowledge and agree without qualifications or reservations to all the terms and conditions stated in this
document. By a copy of this document, I hereby agree and commit to strictly observe shift schedule, `training schedule,
workdays, work hours and break periods. I understand that non-compliance be a valid ground to terminate the
probationary period of an employee for failure to meet the required standards of behavior and performance, consistent
with the provisions of his employment contract.

________________________ ___________________________
Signature over printed name Date
(To be filled out by BIR) DLN:

Application for BIR Form No.

Republic of the Philippines
Department of Finance
Bureau of Internal Revenue
Registration Information
Update/Correction/Cancellation
1905
January 2018 (ENCS)
Fill in applicable spaces. Mark all appropriate boxes with an “X”
PART I - TAXPAYER INFORMATION
1 Taxpayer Identification Number (TIN) 2 RDO Code 3 Contact Number
- - -
4 Registered Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

PART II - REASON/DETAILS OF REGISTRATION INFORMATION UPDATE/CORRECTION

5 Replacement/Cancellation of 6 Other Updates
FORM/S REASON/DETAILS
A. Certificate of Registration (COR) Lost/Damaged Closure of Business
(proceed to Number 8)
Change of Accredited Printer as Requested by Change of Civil Status
B. Authority to Print (ATP) Receipts/Invoices the taxpayer (proceed to Number 9)
Correction/Change/Update of Registration of Update of Books of Accounts
C. Tax Clearance Certificate of Liabilities (TCL1) Information (proceed to Number 10)

D. Taxpayer Identification Number (TIN) Card Others (specify) Avail of 8% Income Tax Rate Option
E. Tax Clearance Certificate for Transfer of Property/ies (TCL2)/
Others (specify)
Certificate Authorizing Registration (CAR)
F. Others(specify)
7 Correction/Change/Update of Registration Information
A. CHANGE IN REGISTERED NAME/TRADE NAME
Registered Name Trade/Business Name
New Registered Name/Trade/Business Name
Old
New
B. CHANGE IN REGISTERED ADDRESS (Old RDO) (New RDO)
Transfer within same RDO Transfer to another RDO From To
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House/Building No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

C. CHANGE IN ACCOUNTING PERIOD (Applicable to Non-Individual) Accounting Start Month Effectivity Date (MM/DD/YYYY)

From Calendar Period to Fiscal

From One Fiscal Period to Another Fiscal Period

From Fiscal to Calendar Period

D. CHANGE/ADD REGISTERED ACTIVITY/LINE BUSINESS

New Registered Activity/Line of Business Effective Date of Change
(MM/DD/YYYY)

E. CHANGE/ADD FACILITY TYPE/DETAILS (attach additional sheet, if necessary)

Additional/New Facility Facility Type*
Facility Type PP - Place of Production BT - Bus Terminal
Facility Code (check applicable facility type) SP - Storage Place RP - Real Property for
.PP .SP WH .SR GG .BT .RP
. .
Others (specify) WH - Warehouse Lease with No
F SR - Showroom Sales Activity
F GG - Garage
Address of Facility
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House/Building No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

 BIR Form No. 1905 – page2

F. CHANGE/ADD INCENTIVE DETAILS/REGISTRATION

Investment Promotion Agency Number of Years

Legal Basis Start Date (MM/DD/YYYY)

Incentives Granted End Date (MM/DD/YYYY)
Registration/Accreditation No. Registered Activity
From To Tax Regime
Effectivity Date Activity Start Date
(MM/DD/YYYY) (MM/DD/YYYY)

Date Issued (MM/DD/YYYY) Activity End Date

(MM/DD/YYYY)

G. CHANGE/ADD TAX TYPE DETAILS/SUSPEND TAX TYPE/RE-REGISTER TAX TYPE

Form Type ATC Effectivity Date of Change
Suspend/Cancelled Tax Type/s (MM/DD/YYYY)
(to be filled-up by BIR)

Form Type ATC Effectivity Date

Re-register/Added/New Tax Type/s (MM/DD/YYYY)
(to be filled-up by BIR)

H. CHANGE/UPDATE OF CONTACT TYPE

Phone Number Mobile Number Fax Number
Email Address (required)

I. CHANGE/UPDATE OF CONTACT PERSON/AUTHORIZED REPRESENTATIVE

(Last Name, First Name, Middle Name, Suffix)

Position TIN
- - -

J. CHANGE/UPDATE OF NAME OF STOCKHOLDERS/MEMBERS/PARTNERS

(Last Name, First Name, Middle Name, Suffix, If Individual OR Registered Name, if Non Individual)
A
B
C
TIN
A - - -
B - - -
C - - -

8 Closure of Business/Cancellation of Registration

A. CANCELLATION OF TIN
Death As a result of merger/consolidation
Multiple/Identical TIN Others (specify)
Failure to start/commence business (For Non-Individual)
Permanent closure of a branch Effective Date of Cancellation (MM/DD/YYYY)
Dissolution of corporation/partnership

B. DE-REGISTER/CESSATION OF REGISTRATION
Permanent closure of business (head office) of an individual Trade/Business Name

Others (please specify)

Effective Date of Cessation
(MM/DD/YYYY)

9 Change of Civil Status From Single to Married From Married to Single

A. Old Name/Maiden Name (First Name, Middle Name, Last Name, Suffix)

B. New Name/Married Name (First Name, Middle Name, Last Name, Suffix)

C. Spouse Information
Employment Status
of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
Spouse Name (Last Name) (First Name)

(Middle Name) (Suffix) Spouse TIN

0 0 0 0 0
Spouse Employer’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

Spouse Employer’s TIN - - -

 BIR Form No. 1905 – page 3
10 Books of Accounts
Type (Manual or Volume
Type of Books to be Registered Quantity
Loose) From From

Date Registered Permit Number Date Issued (MM/DD/YYYY)

(MM/DD/YYYY)

11 Other Update/Correction (please specify details) For Taxpayer For BIR Use

Effective Date
of Change Approved by:
(MM/DD/YYYY)
REVENUE DISTRICT OFFICER Date
(Signature over Printed Name)
12 Declaration Stamp of BIR Receiving Office
I declare, under the penalties of perjury, that this application has been made in good faith, verified by me and to the best of my and Date of Receipt
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the
regulations issued under authority thereof. Further, I give my consent to the processing of my information as contemplated under the
*Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

____________________________________________________ ______________________
TAXPAYER/AUTHORIZED REPRESENTATIVE/TAX AGENT Title/Position of Signatory
(Signature over Printed Name)

*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)
Documentary Requirements
REPLACEMENT/CANCELLATION E. Change/Add Facility Type/Details
A. Certificate of Registration 1. Appropriate Application for Registration and requirements therein
1. Original Copy of Old Certificate of Registration, for replacement F. Change/Add Incentive Details/Registration
2. Affidavit of Loss, if lost 1. Certificate of Accreditation/Registration from Investment Promotion Agency
3. Proof of payment of Certification Fee and Documentary Stamp Tax - to be submitted before the I. Change/Update of Contact Person/Authorized Representative
issuance of the new Certificate 1. Authorization or Certification issued by Officer enumerated under Section 52 (A) of the Tax Code
B. Authority to Print (ATP) Receipts and Invoices (President or representative and Treasurer or Assistant Treasurer of the Corporation)
1. Original Authority to Print Primary and Secondary Receipts/Invoices J. Change/Update of Stockholders/Members/Partners
2. New Application Form (BIR Form No. 1906), if applicable 1. Amended Articles of Incorporation/Cooperation/Partnership
3. Affidavit of Loss, if lost
C. Tax Clearance Certificate for Tax Liabilities (TCL1) CLOSURE OF BUSINESS/CANCELLATION OF REGISTRATION
1. Affidavit of Loss, if lost 1. Death Certificate, in case of death of an individual;
2. Proof of payment for Certification Fee and Documentary Stamp Tax-to be submitted before the issuance 2. List of ending inventory of goods, supplies, including capital good;
of the new Tax Clearance Certificate 3. Inventory of unused sales invoices/official receipts (SI/OR);
3. TCL1, if for replacement 4. Unused sales invoices/official receipts and all other unutilized accounting forms (e.g., vouchers,
D. TIN Card debit/credit memos, delivery receipts, purchase orders, etc.) including business notices and
1. Affidavit of Loss, if lost permits as well as COR shall be subject for destruction to be witnessed by BIR personnel and
2. Old TIN Card (if replacement is due to damaged card) officials.
3. Marriage Certificate (for change of Family Name)
CHANGE OF CIVIL STATUS
4. SEC Certificate (for Change of Corporate Name) 1. Marriage Contract or Court Order (declaration of nullity of marriage); and
CORRECTION/CHANGE/UPDATE OF REGISTRATION INFORMATION 2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
A. Change in Registered Name/Trade Name
UPDATE OF BOOKS OF ACCOUNT
1. Amended SEC Registration/DTI Certificate; and
1. Photocopy of the first page of the previously approved books
2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
B. Change in Registered Address REGISTRATION OF BOOKS OF ACCOUNTS
FROM OLD RDO A. Manual Books Of Account
1. Inventory List of unused principal and supplementary receipts/invoices for destruction if not to be used 1. New sets of permanently bound books of accounts
in the new RDO or request letter for approval of use of the unused receipts/invoices in new RDO B. Manual Loose Leaf Books Of Accounts
FROM NEW RDO 1. Permit to Use Loose Leaf Books of Accounts;
1. Photocopy of Amended Articles of Incorporation/Partnership bearing the taxpayer’s new principal 2. Permanently bound Loose Leaf Books of Accounts; and
business address and Certificate of Filing of Amended Articles of Incorporation (only for Non-Individual 3. Affidavit attesting the completeness, accuracy and correctness of entries in Books of Accounts
taxpayers); and the number of Loose Leaf used for period covered.
2. Photocopy of Mayor’s Business Permit; or Duly received Application for Mayor’s Business Permit, if the C. Computerized Books Of Accounts
former is still in the process with the LGU; 1. Permit to Use Computerized Accounting System (CAS)/Computerized Books of Accounts
3. Unused principal and supplementary receipts/invoices for re-stamping per approved inventory list by old (CBA) and/or its Components;
RDO; 2. DVDs containing Electronic Books of Accounts and Records. The DVDs should be properly
4. Transfer Commitment Form. authenticated and its labels duly signed by the responsible official(s) of the company who are
C. Change in Accounting Period required to sign the tax returns under the Tax Code, using a permanent marker;
1. Photocopy of the Securities and Exchange Commission (SEC) Certificate of Filing of Amended By-Laws 3. Affidavit attesting the completeness, accuracy and appropriateness of the computerized
showing the change in accounting period. accounting books/records, in accordance with the keeping of books of accounts and records for
D. Change/Add Registered Activity/Line of Business internal revenue tax purposes.
1. Photocopy of Amended Mayor’s Permit or SEC Certificate of Registration if applicable; and
2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
 PMRF
PHILHEALTH MEMBER REGISTRATION FORM
UHC v.1 January 2020

REMINDERS:
PHILHEALTH IDENTIFICATION NUMBER (PIN)
1. Your PhilHealth Identification Number (PIN) is your unique and permanent
PURPOSE:
number.
2. Always use your PIN in all transactions with PhilHealth. REGISTRATION UPDATING/AMENDMENT
3. For Updating/Amendment check the appropriate box and provide details to Preferred KonSulTa Provider
be accomplished and submit corresponding supporting documents.
4. Please read instructions at the back before filling-out this form.

I. PERSONAL DETAILS
NAME NO
MIDDLE MONONYM
LAST NAME FIRST NAME EXTENSION MIDDLE NAME NA ME
(Jr./Sr./III)
(Check i f app li cable onl y)

MEMBER
MOTHER’s
MAIDEN NAME
SPOUSE
(If Married)

DATE OF BIRTH PLACE OF BIRTH (City/Municipality/Province/Country)

(Please indicate country if born outside the Philippines) PHILSYS ID NUMBER (Optional)

m m d d y y y y
SEX CIVIL STATUS CITIZENSHIP TAX PAYE R IDE NTIFICATION NUMBER (TIN) (Optional)
Male Single Annulled FILIPINO FOREIGN NATIONAL
Female Married Widow/er
Legally Separated
DUAL CITIZEN

II. ADDRESS and CONTACT DETAILS

PERMANENT HOME ADDRESS Hom e Phone Number
Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name

(COUN TRY C OD E + AR EA CODE + TEL EPHONE NUM BER)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code
Mobile Number (Required)

MAILING ADDRESS SAME AS ABOVE

Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name Bus iness (Direct Line)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code E-mail Address (Required for OFW)

III. DECLARATION OF DEPENDENTS (Use additional form if necess ary )

DATE OF NO Chec k if
NA ME MIDDLE MONONYM
BIRT H with
LAST NAME FIRST NAME EXTENSION
(Jr./Sr./III)
MIDDLE NAME RELATIONSHIP
(mm-dd-yyyy)
CITIZENSHIP NA ME Per manent
Disa bility
(Check i f app li cable onl y)

IV. MEMBER TYPE

DIRECT CONTRIBUTOR INDIRECT CONTRIBUTOR
Employed Private Kasambahay Family Driver
Listahanan LGU-sponsored
Employed Government Migrant Worker
4Ps/MCCT NGA-sponsored
Professional Practitioner Land-Based Sea-Based
Senior Citizen Private-sponsored
Self-Earning Individual Lifetime Member
Filipinos with Dual Citizenship / Living Abroad PAMANA Person with Disability
Individual
KIA/KIPO PWD ID No. ______________
Sole Proprietor Foreign National
Group Enrollment Scheme PRA SRRV No. _____________________ Bangsamoro/Normalization
____________________ ACR I-Card No. _____________________
For PhilHealth Use only:
PROFESSION: (Except Employed, Lifetime Members and MONTHLY INCOME: PROOF OF INCOME: Point of Service (POS) Financially Incapable
Sea-based Migrant Worker)
Financially Incapable

This form ma y be reproduce d and is not f or sale Continue at the bac k

 V. UPDATING/AMENDMENT
Please check: FROM TO
Change/Correction of Name
(Last Name, First N ame, Name Extension (Jr./Sr./III) Middle Name)

Correction of Date of Birth

Correction of Sex

Change of Civil Status

Updating of Personal Information/Address/

Telephone Number/Mobile Number/e-mail
Address

FOR PHILHEALTH USE ONLY

Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
authorize PhilHealth for the subsequent validation, verification and for other data sharing
RECEIVED BY:
purposes only under the following circumstances:

 As necessary for the proper execution of processes related to the legitimate and Full Name:
declared purpose;
 The use or disclosure is reasonably necessary, required or authorized by or under the ______________________________
law; and,
 Adequate security measures are employed to protect my information. PRO/LHIO/Branch:

_____________________________

Date & Time:

_________________________________________________ _________________
Member’s Signature over Printed Name Date Plea se affix right
______________________________
thumbmark if unable to write

INSTRUCTIONS

1. All information should be written in UPPER CASE/CAPITAL LETTERS. If the information is not applicable, write “N/A.”
2. All fields are mandatory unless indicated as optional. By affixing your signature, you certify the truthfulness and accuracy of all
information provided.
3. A properly accomplished PMRF shall be accompanied by a valid proof of identity for first time registrants, and supporting
documents to establish relationship between member and dependent/s for updating or request for amendment.
4. On the PURPOSE, check the appropriate box if for Registration or for Updating/Amendment of information.
5. Indicate preferred KonSulTa provider near the place of work or residence.
6. For PERSONAL DETAILS, all name entries should follow the format given below. Check the appropriate box if registrant has no
middle name and/or with single name (mononym).

LAST NAME FIRST NAME NAME EXTENSION (Jr./Sr./III) MIDDLE NAME

SANTOS JUAN ANDRES III DELA CRUZ

7. Indicate registrant’s/member’s name as it appears in the birth certificate.

8. The full mother’s maiden name of registrant/member must be indicated as it appears in the birth certificate.
9. Indicate the full name of spouse if registrant/member is married.
10. Indicate the complete permanent and mailing addresses and contact numbers.
11. For updating/amendment, check the appropriate box to be updated/amended and indicate the correct data.
12. For MEMBER TYPE, check the appropriate box which best describes your current membership status.
13. For Direct Contributors, except employed, sea-based migrant workers and lifetime members, indicate the profession, monthly
income and proof of income to be submitted.
14. For Self-earning individuals, Kasambahays and Family Drivers, indicate the actual monthly income in the space provided.
15. In declaring dependents, provide the full name of the living spouse, children below 21 years old, and parents who are 60 years old
and above totally dependent to the member.
16. Dependents with disability shall be registered as principal members in accordance with Republic Act 11228 on mandatory
PhilHealth coverage for all persons with disability (PWD).
17. The registrant must affix his/her signature over printed name (or right thumbmark if unable to write) and indicate the date when the
PMRF was signed.
 

Code of Conduct Statement of Understanding

This is to certify that I have attended the Code of Conduct discussion during the New Hire
Orientation and I have accomplished the Code of Conduct online training and have understood the
material covered.

I was given the opportunity to ask questions about the policies in the handbook. I agree to and will
comply with the policies, procedures, and other guidelines set forth in the handbook. I understand
that the company reserves the right to change, modify, or abolish any or all of the policies, benefits,
rules, and regulations contained or described in the handbook as it deems appropriate at any time,
with or without notice. I acknowledge that neither the Code of Conduct nor its contents are an
express or implied contract regarding my employment.

I, further, understand that all employees of the company, regardless of their classification or
position, are employed on an at-will basis, and their employment is terminable at the will of the
employee or the company at any time, with or without cause, and with or without notice. I have also
been informed and understand that no officer, agent, representative, or employee of the company
has any authority to enter into any agreement with any applicant for employment or employee for
an employment arrangement or relationship other than on an at-will basis and nothing contained in
the policies, procedures, handbooks, or any other documents of the company shall in any way create
an express or implied contract of employment or an employment relationship other than one on an
at-will basis.

The Code of Conduct is a Company property therefore should not be shared, and kept confidential at
all times.

 
Signature Date


Employee’s Name

Noted By:
 Acknowledgement of Employee Handbook

I have attended the orientation and I confirm having fully-understood the material/s
covered, including discussion of the Employee Handbook (“Handbook”). I have had the
opportunity to ask questions about the policies in this Handbook, and I understand that any
future questions that I may have about the Handbook or its contents will be answered by the
Manager or his or her designated representative upon request.

I agree to, and commit to comply with the policies, procedures, and other guidelines set
forth in the Handbook. I understand that the Company reserves the right to change, modify,
or abolish any or all of the policies, benefits, rules, and regulations contained or described in
the Handbook as it deems appropriate at any time, with or without notice. I understand that
the responsibility of reading and updating myself with any changes, modification, and/or
abolition of any or all of the policies, benefits, rules and regulations in the Handbook, as may
be duly-published is incumbent upon me.

I acknowledge that neither the Handbook nor its contents are an express or implied
contract regarding my employment.

I further understand that all employees of the company, regardless of their classification
or position, are employed voluntarily, such that the employer-employee relationship may be
severed either by the employee by resignation, or by the company for just cause/s in
accordance with relevant laws,

I have also been informed and understand that no officer, agent, representative, or
employee of the company has any authority to enter into any agreement with any applicant
for employment or employee for an employment arrangement or relationship other than on a
voluntary l basis and nothing contained in the policies, procedures, Handbooks, or any other
documents of the company shall in any way create an express or implied contract of
employment or an employment relationship other than one that is voluntary.

This Handbook is a company property and must not be shared outside company premises.

Signature Date

Employee Name: Printed

 Generali Life Assurance Philippines, Inc.
10th Floor, Petron Mega Plaza
Sen. Gil J. Puyat Ave., Makati City
1227 Philippines
T (632) 000-0000
F (632) 000-0000
www.generali.com

APPLICATION FOR GROUP TERM LIFE INSURANCE

Last Name First Name Middle Name FOR HOME OFFICE USE ONLY
Date of Birth (MM/DD/YYYY) Place of Birth Civil Status Sex Policy No.
Certificate No.
Employer/Association/Union Job Title Effective Date
†
†Employee
Date of Employment/Membership Date of Permanent Appointment †
†Employee and Dependents

FOR GROUP LIFE INSURANCE FOR POLICY WITH DEPENDENT’S COVERAGE

Name of Beneficiary Date of Birth Relationship Name of Dependents Date of Birth Relationship

I HEREBY CERTIFY that the personal data contained herein are true and correct.

APPLICANT’S SIGNATURE DATE SIGNED

 TRAINING AGREEMENT FOR PROBATIONARY EMPLOYEES
Consistent with your employment contract, you will be on probationary status for no more than one hundred eighty (180) days from the start of
your employment. During this period, the Company will evaluate your performance, among others, in terms of your dependability, efficiency,
initiative, attitude (as regards our customers, the Company and its officers and your colleagues), cooperation, client response, judgment,
punctuality, quality and quantity of work, and professionalism

By a copy of this document, you hereby agree and commit tostrictly observe the following implementing guidelines:

I. ATTENDANCE

Attendance and schedule adherence is critical in completing learning, training, and development opportunities.

1. Employee should not miss any portion of the learning, training, and development opportunities. However, Sutherland will require a
minimum of 95% attendance completion to acquire minimum skills requirement for the job. See below for applicable allowable
absences per training length:

a. A maximum of two (2) absences for employees undergoing training that runs for less than 40 business days (or eight
training weeks)
b. A maximum of three (3) absences for employees undergoing training that runs for 40 business days to 60 business days
c. A maximum of four (4) absences for employees undergoing training that runs for 61 business days to 80 business days
d. Exemptions will be managed between senior leaders of Human Resources and Training (Senior Manager and/or Director).
2. Employee shall receive a documented coaching log from Trainer/Training Manager for all instances of absences regardless of reason.
3. Employee shall adhere to the call-in process (see Article III: Call-In Process) for all instances of absences regardless of reason.
4. Failure to adhere to any aforementioned guidelines on attendance is a ground for non-regularization due to inability to meet the
required standard performance at work.

II. TARDINESS

An employee is considered on time if he/she has clocked in through Sutherland’s timekeeping tool AND is physically present at the training facility
or office location where the training is being held on or before the start of shift. Employee is also expected to return to the training facility on time
after breaks and lunches.

1. However, if employee will be tardy, he should follow the Call-In Process indicated in Article III below.

a. The company will allow a total accumulated tardy minutes not exceeding 60 minutes or a maximum of four (4) instances
whichever comes first.
b. Anything in excess of 60 minutes or 4 instances will merit disciplinary action as stated in Sutherland’s code of conduct.
c. An instance of tardiness that exceeds two (2) hours shall be considered half a day of absence and will be taken against the
allowable two-day absence as outlined in Article I.1.a.

III. CALL-IN PROCESS

In cases of absences, under time or tardiness, employee is required to call the authorized contact person (Name of Contact Person and Mobile
Number) at least one hour before the start of the training to properly notify the company the(1) reason for absence/tardiness, (2) employee’s
commitment to return to workand (2) a contact number to reach the employee.

1. Failure to notify the authorized contact person stated above prior to start of training is considered by the company as No Call/No
Show (NCNS). As per Sutherland’s code of conduct, NCNS is considered an occurrence of unexcused absence and is grounds for
disciplinary action up to and including separation from the company.
a) 1st Instance – Final Written Warning
b) 2nd Instance – Termination via non-regularization

2. A Call-In is considered valid when:

a) The employee himself/herself contacts the authorized contact person through the abovementioned number.
 b) An immediate family member contacts the authorized contact person on behalf of the employee for extenuating
circumstances wherein employee is unable to speak.

3. A Call-In is considered invalid when:

a) Authorized contact person is notified through any social media platform.
b) Authorized contact person is notified through a peer trainee/co-employee.
c) The call-in is made after the shift has started.

IV. USE OF ELECTRONIC DEVICES, TECHNOLOGY AND COMPANY EQUIPMENT AND FACILITIES

1. Devices such as, but not limited to mobile phones, smart watches, tablets, ipods, headsets, laptops, gaming console and other
similar electronic devices, smart devices and gadgets are strictly prohibited inside the Training Facility. These should be kept inside
lockers or deposited with the Security Personnel on duty.

2. Computers inside the training facility shall not be used to access your personal mails, social media accounts, and any and all non-
work related websites.Computers shall be turned on/turned off only upon the advice of your trainer-facilitator.Removal or
tampering of company equipment is strictly prohibited.

3. Employee is expected to take care of the equipment and facilities of the company.Cleanliness of the training room should be
maintained. Garbage bins are placed inside the room for your use. Food/snacks are not allowed inside the training room. Only spill
proof liquid containers are allowed

V. TRAINING CERTIFICATION
1. Employee shall undergo Communications and Language Training, Product Training and Nesting (Transaction Handling) Assessment
and Certification in order to pass training and receive an endorsement to production / operation.
2. Failure to pass Training, Assessment and Certification shall cause removal from training and the company.
3. Attached in the next page is the Training Certification Agreement that outlines the client expectations, the training goals and targets,
and Certification requirements. (Please append your Program Training Certification agreement)

Failure to adhere to any aforementioned guidelines is a ground for non-regularization due to inability to meet the required standard
performance at work.

ACKNOWLEDGMENT

I have received a copy of this policy and have read and understand the material covered. I have had the opportunity to ask questions about the
policies in this handbook, and I understand that any future questions that I may have about the handbook or its contents will be answered by the
Office Manager or his or her designated representative upon request. I agree to and will comply with the policies, procedures, and other guidelines
set forth in the policy. I understand that the company reserves the right to change, modify, or abolish any or all of the policies, benefits, rules, and
regulations contained or described in the policy as it deems appropriate at any time, with or without notice. I acknowledge that neither the policy
nor its contents are an express or implied contract regarding my employment.

_________________________________ ________________________________
Employee Signature over Printed Name Training Manager Signature over Printed Name

_________________________________ ________________________________
Date Date
 CONFIDENTIALITY AND INTELLECTUAL PROPERTY AGREEMENT

I, _____________________________ hereby agree to the terms and conditions of this

Confidentiality and Intellectual Property Agreement (this “Agreement”) in consideration of my
employment or continued employment by Sutherland Global Services Philippines Inc., (“Company”).

1. CONFIDENTIALITY. During my Company or its designee, at no charge, all of my

employment by the Company and at all times right, title and interest in and to any and all
thereafter, I will hold in strictest confidence, and Intellectual Property (as defined below) with respect
will not use or disclose, any Confidential to any works, inventions or other materials that I,
Information ( as defined below), except to the whether solely or jointly with others, create
extent such use or disclosure may be required in conceive or reduce to practice in the course of my
connection with my work for the Company. employment at the Company or using the time,
“Confidential Information” means any and all facilities or property of the Company. I will, at the
confidential and/or proprietary knowledge, Company’s request promptly execute a written
documents, computer files, data and other assignment to the Company of any such Intellectual
information and materials of the Company, or of Property and will cooperate with the Company to
its customers, suppliers or other third parties to the extent reasonable with respect to the protection
whom the Company may have an obligation of and enforcement of any such Intellectual Property.
confidentiality, whether I first learned of such “Intellectual Property” means all rights,
information or materials before or after the date I worldwide, to any inventions (whether or not
sign this Agreement, including, but not limited to, patentable), patents, patent applications, copyrights,
all non-public information and materials relating trade secrets, know-how and other intellectual
to: (i) the company’s products and services, (ii) property rights.
the Company’s pricing strategies, pricing models
and cont structures, (iv) service delivery methods 3. RETURN OF COMPANY MATERIALS.
and other business processes and methods of the Upon termination of my employment with the
Company, (iv) customer lists, supplier lists and Company for any reason whatsoever, voluntarily or
other information regarding the Company’s involuntarily, and at any earlier time that the
customers or suppliers, (v) the Company’s Company requests, I will deliver to the person
business plans and marketing plans, (vi) the designated by the Company all originals and copies
Company’s management and financial reports, of all documents, computer files, keys identification
(vii) software source codes and object codes of cards and other property of the Company in my
the Company, (viii) the Company’s research and possession, under my control or to which I may
development activities and (ix) the Company’s have access. I will not reproduce or appropriate for
employee records, personnel files, information my own use, or for the use of others, any property
relating to employee roles and capabilities, and (including but not limited to intellectual Property)
compensation information. In addition, of the Company or any Confidential Information.
confidential Information shall include any
information and materials that are marked as 4. OBLIGATIONS TO FORMER
proprietary or confidential information of the EMPLOYERS. During my employment by the
company, or that I am told (or that I reasonably Company, I will not improperly use or disclose any
would be expected to know) are proprietaryconfidential
or or proprietary information or trade
confidential information of the Company. secrets of any former employer or any other
2. INTELLECTUAL PROPERTY.person I hereby
to whom I have an obligation of
assign, and agree to assign in the future,
confidentiality,
to the and I will not bring onto the
premises of the Company any unpublished
documents or any other materials containing such 9. SEVERABILITY. The invalidity or
confidential or proprietary information or trade unenforceability of any one or more of this
secrets unless consented to in writing by that Agreement’s terms or provisions shall not impair or
former employer or person. affect the validity or enforceability of the remaining
terms or provisions, and this Agreement shall be
5. AUTHORIZATION TO NOTIFY construed and enforced as if the invalid or
SUBSEQUENT EMPLOYER. I hereby unenforceable term or provision had not been
authorize the Company to notify any subsequent contained in this Agreement. If any term or
employer about my rights and obligations under provision contained in this Agreement is adjudged
this Agreement following the termination of my by a court of competent jurisdiction to be
employment with the Company. excessively broad as to duration, scope or subject,
the term or provision shall be limited and reduced
6. LEGAL AND EQUITABLE so as to be enforceable under applicable law.
REMEDIES. Because my services are personal
and unique and because I may have access to and 10. SUCCESSORS AND ASSIGNS. This
become acquainted with the Confidential Agreement will be binding upon my heirs,
Information, the Company shall have the right to executors, administrators and other legal
enforce this Agreement and any of its provisions representatives and will be for the benefit of the
by injunction, specific performance or other Company, its successors, and its assigns.
equitable relief, without bond and without
prejudice to any other rights and remedies that the 11. SURVIVAL. The provisions of this
Company may have for a breach of this Agreement shall survive the termination of my
Agreement. In the event that any suit or action is employment and the assignment of this Agreement
instituted to enforce any provision of this by the Company to any successor in interest or
Agreement, the prevailing party shall be entitled other assignee.
to recover from the losing party all fees, costs and
expenses of enforcing any right of such prevailing 12. MODIFICATION AND WAIVERS. No
party under or with respect to this Agreement modification of or amendment to this Agreement,
(including, without limitation reasonable fees and nor any waiver of any rights under this Agreement,
expenses of attorneys, accountants and expert will be effective unless in writing and signed by the
witnesses), which shall include, without party to be charged.
limitation, all fees, costs and expenses of appeals.
13. ENTIRE AGREEMENT. This Agreement
7. EMPLOYMENT. I agree and understand is the final, complete and exclusive agreement of
that nothing in this Agreement shall confer any the parties with respect to the subject matter hereof
right with respect to continuation of my and supersedes and merges all prior discussions
employment by the Company, not shall it interfere between us; provided, however, that,
in any way with any right that I or the company notwithstanding the foregoing, to the extent I have
may have to terminate my employment at any entered into any other agreement containing
time, with or without cause. Any subsequent provisions that are more protective of the
change or changes in my duties, salary or Company’s confidential information and other
compensation will not affect the validity or scope rights than are the provisions of this Agreement,
of this Agreement unless otherwise expressly such more protective provisions shall not be
stated in writing by the Company. superseded, but rather shall continue in effect in
accordance with their terms.
8. APPLICABLE LAW. This Agreement will
be governed by and construed according to the laws
of Philippines.
By signing below, I accept and agree to the terms and conditions of this Agreement, effective as
of the first day of my employment with the Company:

___________________________________________
(Signature)
___________________________________________
(Printed Name)
___________________________________________
(Address)
___________________________________________
(Date)

ACKNOWLEDGED ON BEHALF OF SUTHERLAND GLOBAL SERVICES PHILIPPINES INC.

___________________________________________

__________, 201____
 Workstation, Computer, Internet and
Production Floor Guideline

I, ______________________________, have read, understood and agree to the

terms and conditions of this Workstation, Internet and Production Floor Guideline in
consideration of my employment or continued employment with Sutherland Global
Services Inc.

I. The following items are strictly prohibited:

1. Uploading and, or, transmitting materials that contain viruses or any harmful
programs that would result to corruption, destruction, alteration of any
electronic data and information.
2. Using Company computers or other electronic devices for hacking purposes;
unauthorized access into or interference in a computer system and server.
3. Piracy or unauthorized reproduction, dissemination, importation, use,
removal, substitution, modification, storage, uploading, downloading,
communication or making available to the public, of the Company's protected
material and copyrighted items.
4. Initiating and, or, downloading network games which may affect the
functionality of the Company’s network and systems.
5. Consenting to, tolerating, or allowing another employee to use his/her
password or login code to gain access to a server, directory, files, or physical
entry to which the accessing employee has not been duly authorized for.
6. Unauthorized duplication and, or, possession of any confidential files or data.
7. Tampering with server and network configurations, changing the server or
network rights of users and creating unauthorized user accounts on the
server.
8. Posting and, or, transmitting sexually explicit and other related images,
narrative or nay data that are sexual in nature.
9. Surfing on any non-work related sites.
10. Online discussion of obscene topics, or using offensive, bigoted, hateful or
racially offensive statements.
11. Negligence or the careless act of leaving the computer unattended thereby
risking a possible data security infringement.

II. Additionally, I am also conforming to the following guidelines:

1. I would not leave any access doors kept open at any time
2. To swipe my access card each time I make an entry or exit
3. No files are stored on the desktops of my system
 4. No print outs or papers are left unattended over my desk
5. Fire exits are kept closed and used only for emergency purposes
6. No passwords are shared, written, posted anywhere
7. Not to share passwords if somebody asks me to disclose it even if it is my
colleagues, superiors, technology members, auditors
8. USB drives, CD drives are disabled in my systems
9. Not to carry any types of external storage media devices (CD’s, DVD’s, Pen
drives etc) inside the floor
10. No EXE files, flash games, other unauthorized software’s are installed, stored
in my systems
11. Antivirus are updated with the latest version in my PC’s, laptops
12. To wear and display my access cards/ID’s all the time
13. To keep your systems locked/logged off when you are moving away from
your seat
14. Not to take mobiles inside the program floor
15. That I don’t have any local administrator rights in my systems unless
otherwise approved for business needs
16. No client related sensitive information’s are stored in my systems, mail boxes
unless otherwise approved for business needs”

I Hereby acknowledge that I will safeguard the knowledge acquired, stored,

transferred and analyzed by Sutherland Global Services Pvt. Ltd. using adequate
controls which will ensure confidentiality, integrity and availability of all such
information as per laid down practices.

Conforme:

_________________________________
Signature over printed name

_________________________________
Date and Time
(FOR EDD)
 Remote Work Agreement
1. This is an agreement between __________________(“the department”) and _________(“Employee”)
to establish the terms and conditions while work is performed remotely, outside a Sutherland-
controlled facility. This agreement is a supplement to the original employment contract and does not
aim to supersede the same.
2. This agreement begins on_____________ and continues indefinitely while the employee continues to
work in the same role and the same department. The company reserves the right at any time to
review and revise the terms of this agreement, or even discontinue the same, and to require the
employee to report back to the office temporarily or permanently for any of the reasons specified in
Sutherland’s Remote Work Policy with at least one (1) week prior notice, subject to any local
legislation requirements on the matter.
3. The following work conditions apply:
a. Employee’s regular teleworking schedule is;
☐ Regular, from: ______ to: ______
☐ Flexible
Employee commits to secure supervisor approval in advance of working any overtime hours (if non-
exempt or hourly paid) and comply with applicable company policies on time and attendance.
b. Employee’s official remote work location is _______________________________ .
c. Employee’s official teleworking phone number is ________________________.
4. By signing this agreement, the employee confirms that s(he) will comply with the company’s Remote
Work policy. The employee also understands the need to comply with all Information Security, Ethics
& Compliance and Human Resources policies and any other company policies that apply by virtue of
the employee’s role/level/location, as if working in a Sutherland controlled office.
5. Employee’s duties, obligations, responsibilities, and conditions of employment with Sutherland remain
unchanged except those obligations and responsibilities specifically addressed in this agreement.
6. Compensation and benefits, access to training, participation in corporate employee events,
opportunities for lateral or vertical promotion and/or participation in other talent management activities
will not be differentiated by virtue of the employee working remotely in comparison to similarly
situated employees working at a Sutherland controlled office.
7. Regarding space and equipment purchase, set-up, and maintenance for telecommuting purposes:
Provided By
Work Tools
Company Employee
Laptop/Desktop ☐ ☐
Internet (min 10 Mbps + Unlimited download) ☐ ☐
System Software ☐ ☐
Others ☐ ☐

Company provided tools shall remain the property of the company and used for work purposes only,
to be returned within the deadline provided by the company upon cessation of employment or upon
request of the company.

Employee agrees to report to Employee’s supervisor any incidents of loss, damage, or unauthorized
access at the earliest reasonable opportunity.
8. The employee shall be responsible for ensuring that the remote workplace or office complies with
Health & Safety standards recommended by Sutherland and/or required by local regulations.

________________________________________ ________________________
[Insert Employee’s Name] Date

________________________________________ ________________________
[Insert Supervisor’s/Company Representative’s Name] Date
 Information Security / Clean Desk “Work at Home”
Employee Attestation

Complete trust and integrity sit at the heart of everything we stand for here at Sutherland. It is
unprecedented situations like the one we find ourselves in now, with the COVID-19 outbreak, that
reinforce the importance of trust as we work together to maintain the integrity of our business. Each
one of us plays a vital role in ensuring that we continue to foster an environment where our Values and
Winning Behaviors are evident in all that we do.
In order to prevent the spread of COVID-19 through community transmission, you will begin to Work at
Home on behalf of Sutherland and our clients. Please read and confirm your commitment to work in a
safe and secure environment:

• As committed in the Non-Disclosure Agreement, I will hold in strictest confidence, and will not
misuse or disclose to any unauthorized person, any Confidential Information belonging to our
clients, end customers, or our company.

• I will collect ONLY the information that is required to provide the necessary service or support
as defined by the process, always respecting individual rights to data privacy.

• I will enter the required information directly into the system and in the field(s) as defined by the
process and not store, write, or copy customer information anywhere else.

• I will not use unsecured public WIFI and will work only through a secure connection via
Sutherland’s or the client’s VPN or a Secure Wi-Fi / LAN Connection (where applicable), whether
I use a Sutherland, or a client issued laptop / desktop or a personal computer.

• I will not print, download or save company information on my personal computer or external
storage devices.

• I will ensure that my work area is secure, and my monitor is set up in such a way that it is not
visible to anyone other than myself.

• I will not share business information with anyone who does not have a legitimate business need
to know.

• I will not misuse benefits that are meant as a privilege to the customers such as promo codes,
vouchers, or coupons, for personal gain.

• I will use company provided email, access to company or client systems, data, and other
corporate resources for business purposes ONLY.

• I will not send company information outside the Sutherland or client network, including my
personal email account.
• I will lock my computer when stepping away (including lunch / breaks) and turnoff the computer
and monitor(s) during non-working hours.

Information Security / Clean Desk “Work at Home” Employee Attestation – COVID 19 03/17/20
Internal Use Only
 • I will never leave company information unattended and I will not browse non-business-related
information on the computer (whether company provided or my personal computer) that I am
using to support our clients.
• I will not use personal electronics such as cell phones, smart watches, personal computers or
laptops, tablets, etc. that are capable of capturing, storing or communicating company, customer
and/or client-related information. These devices will be stored outside of my work area to protect
our clients’ confidential information and to prevent unauthorized disclosure.

• I will not click on pop-ups, links, or attachments that look suspicious or that come from an
unknown sender.

• I will not let friends or family use the computer that I am using to support our customers.
I understand that the work from home arrangement is temporary and will be discontinued by the
company should the threat of the COVID-19 virus dissipate, or if I:

• Fail to demonstrate the attitude and work ethics needed to be productive and successful in
a remote work environment;
• Fail to consistently provide adequate internet connectivity and / or a noise-free environment
resulting to repeated disruptions;
• Fail to comply with any of the provision of Sutherland’s Remote Work Policy, Information
Security and Data Protection Policy and other relevant policies; or
• Should my performance deteriorate or fall below acceptable levels.

I also understand that any violation of this agreement or aforementioned company policies will result in
consequences, up to and including termination.

Click here to sign digitally:

Name:
Sutherland Employee ID:
Today’s Date:

Information Security / Clean Desk “Work at Home” Employee Attestation – COVID 19 03/17/20
Internal Use Only
 HQP-PFF-093
(V04, 01/2019)

REQUEST FOR CONSOLIDATION/

MERGING OF MEMBER’S RECORDS

________________
Date

Dear Sir/Madam:

I would like to request for the consolidation/merging of my membership records with the
following information:

Pag-IBIG MID Number : ________________________________________________

Member’s Name : ________________________________________________
Last Name First Name Name Extension Middle Name
Present Home Address : ________________________________________________
________________________________________________
________________________________________________
Marital Status :  Single/Unmarried  Widow/er  Annulled
 Married  Legally Separated
Contact Number : ________________________________________________
SUTHERLAND GLOBAL SERVICES
Employer/Business Name : ________________________________________________
12F Philplans Corporate CenterTriangle Drive ,Bonifacio Global City,Taguig 1634
Employer/Business Address : ________________________________________________
Employer/Business Contact No. : 4592900x2500
________________________________________________
Purpose of Consolidation/Merging :  Short-Term Loan (STL) Application
 Application for Provident Benefits Claim
 Others, please specify _________________________________

Previous Employer/Business Name Previous Employer/Business Address Inclusive Date(s)

1.
2.
3.
4.
5.

Requesting Pag-IBIG Fund Branch: ______________________________

Requested by: Processed by:

_______________________________ __________________________________
Member’s Name and Signature Name and Designation of Authorized Signatory

Approved by:

__________________________________
Name and Designation of Authorized Signatory