OFFICE OF THE VICE CHANCELLOR FOR FINANCE AND ADMINISTRATION

MEMORANDA 2011

University of the Philippines OPEN UNIVERSITY

Date To Subject Page

11- 001 01/05/2011 All ConcernedFinancial Assistance to the Family of Roselyn

Gacosta1

11- 002 01/05/2011 All ConcernedFinancial Assistance to the Family of Wyomia

Pradas2

11- 003 CANCELLED

11- 004 01/14/2011 All Admin StaffSubmission of Performance Targets (PTs) for

2011 and Performating Ratings (PR )for 20103

11- 005 01/18/2011All UPOU Officials,

Faculty & Staff

Financial Assistance to the Family of Emily

Amoloza4

11- 006 02/16/2011 All Concerned

Discount on All Diagnostic Services Offered at

the UPM-PGH-Faculty Medical Arts Building

(FMAB)

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11- 007 02/16/2011 All Concerned

CSC Memorandum Cicular No. 25 on the

Guidelines on the Availment of the Special

Leave Benefits for Women under RA 9710

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11- 008 02/16/2011 All ConcernedCSC Memo Circulars on Undertime & Half-Day

Absence9

11- 009 03/23/2011 All Concerned Memo on Seminar on Fire Prevention 17

11- 010 03/30/2011 All Concerned

CSC Memo Cicular No. 4 Series of 2011on the

Policy and Guidelines on the Prohibition on the

Consumption of Alcoholic Beverages

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11- 011 03/30/2011 All ConcernedSubmission of Daily Time Record (DTR) &

Certificate of Service (COS)22

11- 012 03/30/2011 All UPOU Employees

2010 Statement of Assets, Liabilities &

Networth and Disclosure of Business Interest

and Financial Connections

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11- 013 04/19/2011All UPOU Officials,

Faculty & Staff

Financial Assistance to the Family of Emely

Amoloza26

11- 014 04/26/2011 All ConcernedUniversity Policies for Authority to Fill Plantilla

Items27

11- 015 04/29/2011 All ConcernedAdoption of Four-day Work Week in the

University31

11- 016 05/11/2011All UPOU Official,

Faculty & StaffDisaster Risk Reduction Seminar 32

11- 017 05/13/2011 All UPOU Employees Pag-ibig Fund/HDMF Updates 33

11- 018 05/31/2011 All UPOU EmployeesFinancial Assistance to the Family of Joane

Serrano34

11- 019 06/14/2011 All ConcernedEarly submission of Peformance Ratings (PRs)

for the Period January to June 201135

11- 020 07/26/2011 Al UPOU EmployeesStatement of Accumulated Value from Pag-ibig

Fund/Hime Development Mutual Fund (HDMF)36

11- 021 07/26/2011 All UPOU Employees Pag-big Fund II 38

11- 022 08/02/2011 All UPOU Employees Transfer to LBP as servicing bank of the GSIS 42

No.

Memoranda for the Year 2011

Office of the Vice Chancellor for Finance and Administration

OPEN UNIVERSITY

University of the Philippines

Date To Subject PageNo.

11- 023 08/31/2011All Administrative

Officers/AssistantsAnnual Medical Exam for 2011 43

11- 024 CANCELLED

11- 025 05/27/2011 All LC CoordinatorsApproved Student Loan for Fist Semester 2011-

201245

11- 026 09/15/2011 All UPOU Employees HDMF Online Membership Registration 46

11- 027 09/22/2011All Administrative

Officers/Assistants

Submission of Project Procurement

Management Plan (PPMP) for 201247

11- 028 10/04/2011 Al UPOU EmployeesFinancial Assistance to the Family of Allan

Pamulaklakin48

11- 029 10/07/2011 Al UPOU Employees PhilHealth Insurance Updates 49

11- 030 10/21/2011 All Concerned Monetization of Leave Credits 50

11- 031 11/03/2011 All LC CoordinatorsApproved Student Loan for Second Semester

2011-201251

11- 032 11/04/2011 All Heads of Units

Deadline for Submission of Requests for Fund

Obligation, Payments of Expenditures for FY

2011 and Liquidation/Settelement of Cash

Advances

52

11- 033 12/06/2011 All Members of UPPFIUPPFI – Cocolife Group Life Insurance

Coverage54

11- 034 12/13/2011 All Concerned Mandatory Christmas Break 55

11- 035 12/21/2011UPOU Officials, Faculty

& StaffAssistance for the Victims of Typhoon Sendong 56

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Name _________________________________________ Position/Income ______________________________

(Surname) (First Name) (M.I.) Office: UP Open University

Address: _______________________________________ Office Address: UPOU Bldg., College, Los Banos, Laguna

_______________________________________________

Spouse Name ___________________________________ Position: ____________________________________

(Surname) (First Name) (M.I.) Office: ______________________________________

1. ASSETS

a. Real Properties

NATURE OF CURRENT

YEAR MODE OF PROPERTY ASSESSED FAIR LAND IMPROVE-

KIND LOCATION ACQUIRED ACQUISITION (Parapherral, VALUE MARKET BUILDING MENTS

conjugal or VALUE ETC.

community)

(Required by R.A. 6713)

Unmarried children below 18 years of age

NAME Date of Birth

SWORN STATEMENT OF ASSETS, LIABILITIES, AND NETWORTH

DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

AND IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE

As of __________________________

A. ASSETS, LIABILITIES AND NETWORTH

ACQUISITION COST

community)

TOTAL P

b. Personal Properties

TOTAL P

2. LIABILITIES (Loans, Mortgage, etc.)

TOTAL P

NETWORTH (Total Assets (1a + 1b) less Total Liabilities (2) TOTAL P

NATURE NAME OF CREDITORS AMOUNT

KINDS YEAR ACQUIRED ACQUISITION COST

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Do you have any business interests and other financial connections including those of your spouse and unmarried

children below 18 years of age living with you in your household?

[ ] Yes [ ] No If yes, give particulars

NAME

To the best of your knowledge, are you related within the fourth degree of consanguinity or of affinity to anyone

working in the government [ ] Yes [ ] No If yes, give particulars.

I hereby certify to the best of my knowledge and information, that these are true statements of my assets

liabilities, networth, business interests and financial connections, including those of my spouse and unmarried

children below 18 years of age and names of my relatives in the government as of _____________________ as

required by and in accordance with Republic Act 6713.

I hereby authorize the Ombudsman or his duly authorized representative to obtain and secure from all

appropriate government agencies, including the Bureau of Internal Revenue, such documents that may show my

NATURE OF BUSINESS DATE OF

NAME OF FIRM/COMPANY ADDRESS INTEREST AND/OR ACQUISITION OR

FINANCIAL CONNECTION CONNECTION

C. IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE

NAME POSITION RELATIONSHIP NAME/ADDRESS OF OFFICE

X

appropriate government agencies, including the Bureau of Internal Revenue, such documents that may show my

assets, liabilities, networth, business interests and financial connections, to include those of my spouse and

unmarried children below 18 years of age living with me in my household covering previous years to include the

year I first assumed office in government.

Date: ___________________, _______

_____________________________ ________________________

Signature of Spouse Signature of Employee

TIN : ______________________ TIN : ______________________

Com.Tax Cert No. : ______________________ Com.Tax Cert No. _________________

Issued at : ______________________ Issued at : ______________________

Issued on :______________________ Issued on :_______________________

SUBSCRIBED AND SWORN to before me this _______ day of __________________, _______ affiant

exhibiting his/her Community Tax Certificate as indicated above.

_________________________

(Person Administering Oath)

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Dear Sir/Madam: I would like to request transfer of my membership records and loan details to the _________________ with the following information: Name of member: Last Name First Name Name Extensions (Jr., Sr., II, etc.) Middle Name (Maiden) Civil Status: θ Single θ Legally Separated θ Married θ Annulled θ Widow/er Home Address: Telephone No.: Present Company/Employer: Company/Employer Address: Telephone No.: Company ID No.: Purpose of Transfer: θ Claims θ Consolidation θ STL μ Intra-branch (within the branch) θ Others, pls. Specify _____________ μ Inter-branch (among branches) Check if with: θ Housing Loan θ STL Takeout date : DV/Check Date : Loan Status : Loan Status : Outstanding Balance : Outstanding Balance :

Name of Previous Company/Employer Company/Employer Address/Contact No. Inclusive Date(s)

1.

2.

3.

4.

Requesting Pag-IBIG Fund Branch: ______________________________ Requested by: Processed by:

Noted by:

FPF400

_____________________ Date

REQUEST FOR TRANSFER OF MEMBER'S RECORDS AND LOAN DETAILS (RTMRLD)

___________________________________ Member's Signature Over Printed Name

Revised 08/2008

UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY (UPOU)

UPOU BLDG., COLLEGE, LOS BANOS, LAGUNA

049-536-6001 TO 06

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MODIFIED Pag-IBIG II REGISTRATION FORM (MP2RF) INSTRUCTIONS

1. Type or print all entries in BLOCK or CAPITAL LETTERS. 2. Submit this form and present at least one (1) valid ID.

THIS FORM MAY BE REPRODUCED. NOT FOR SALE. 7/2010

MODIFIED Pag-IBIG II REGISTRATION FORM (MP2RF) INSTRUCTIONS

1. Type or print all entries in BLOCK or CAPITAL LETTERS. 2. Submit this form and present at least one (1) valid ID.

THIS FORM MAY BE REPRODUCED. NOT FOR SALE. 7/2010

LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., III) MIDDLE NAME NO MIDDLE NAME (Check if applicable)

Pag-IBIG MID No./REGISTRATION TRACKING No.

PRESENT HOME ADDRESS(Unit/Room No., Floor, Building Name or Lot No., Block No., Phase No. and Street Name)

DATE OF BIRTH (mm/dd/yyyy)

(Subdivision, Barangay, Municipality/City, Province and State/Country, if abroad) ZIP Code

CONTACT DETAILS COUNTRY+ AREA CODE TELEPHONE NUMBERS Home

Cell phone

Email Address

EMPLOYER NAME

EMPLOYER ADDRESS (Unit/Room No., Floor, Building Name or Lot No., Block No., Phase No. and Street Name)

(Subdivision, Barangay, Municipality/City, Province and State/Country, if abroad) ZIP Code

GROSS MONTHLY INCOME

AUTHORITY TO DEDUCT (For locally-employed members)

THIS IS TO AUTHORIZE MY PRESENT AND FUTURE EMPLOYER TO DEDUCT MY MP2 MONTHLY CONTRIBUTIONS IN THE AMOUNT OF ___________________________________ (P_____________) FROM MY SALARY AND REMIT THE SAME TO HDMF.

___________________________________________ SIGNATURE OF MEMBER OVER PRINTED NAME

TERMS AND CONDITIONS I HEREBY CERTIFY THAT I FULLY UNDERSTAND THE PROGRAM AND AGREE TO THE FOLLOWING TERMS AND CONDITIONS: 1. THE MP2 PROGRAM IS OPEN TO ALL Pag-IBIG I MEMBERS ONLY. 2. THE REGISTRATION UNDER THIS PROGRAM SHALL BE SOLELY A SAVINGS SCHEME. 3. THE MINIMUM CONTRIBUTION IS P500.00. 4. THE ANNUAL DIVIDENDS SHALL BE CREDITED TO MY ACCOUNT IN ACCORDANCE WITH

EXISTING HDMF POLICY. 5. THE MEMBERSHIP TERM SHALL BE FIVE (5) YEARS RECKONED FROM DATE OF INITIAL

PAYMENT OF CONTRIBUTIONS UNDER THIS PROGRAM. 6. UPON MATURITY, I SHALL RECEIVE MY TOTAL SAVINGS WITH DIVIDENDS.

7. UPON MATURITY, I MAY OPT TO RENEW FOR ANOTHER FIVE (5) YEARS. IF I DID NOT

WITHDRAW NOR RENEW UPON MATURITY, THE DIVIDEND RATE SHALL BE SUBJECT TO EXISTING HDMF POLICY.

8. IN CASE OF ANY CHANGE IN INFORMATION, I SHALL ACCOMPLISH THE MEMBER’S CHANGE OF INFORMATION FORM (MCIF) AND IMMEDIATELY NOTIFY HDMF.

I FURTHER CERTIFY UNDER PAIN OF PERJURY THAT THE INFORMATION GIVEN AND ANY OR ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT MY SIGNATURE APPEARING HEREIN IS GENUINE AND AUTHENTIC. ___________________________________________ ______________ SIGNATURE OF MEMBER OVER PRINTED NAME DATE

LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., III) MIDDLE NAME NO MIDDLE NAME (Check if applicable)

Pag-IBIG MID No./REGISTRATION TRACKING No.

PRESENT HOME ADDRESS(Unit/Room No., Floor, Building Name or Lot No., Block No., Phase No. and Street Name)

DATE OF BIRTH (mm/dd/yyyy)

(Subdivision, Barangay, Municipality/City, Province and State/Country, if abroad) ZIP Code

CONTACT DETAILS COUNTRY+ AREA CODE TELEPHONE NUMBERS Home

Cell phone

Email Address

EMPLOYER NAME

EMPLOYER ADDRESS (Unit/Room No., Floor, Building Name or Lot No., Block No., Phase No. and Street Name)

(Subdivision, Barangay, Municipality/City, Province and State/Country, if abroad) ZIP Code

GROSS MONTHLY INCOME

AUTHORITY TO DEDUCT (For locally-employed members)

THIS IS TO AUTHORIZE MY PRESENT AND FUTURE EMPLOYER TO DEDUCT MY MP2 MONTHLY CONTRIBUTIONS IN THE AMOUNT OF ___________________________________ (P_____________) FROM MY SALARY AND REMIT THE SAME TO HDMF.

___________________________________________ SIGNATURE OF MEMBER OVER PRINTED NAME

TERMS AND CONDITIONS I HEREBY CERTIFY THAT I FULLY UNDERSTAND THE PROGRAM AND AGREE TO THE FOLLOWING TERMS AND CONDITIONS: 1. THE MP2 PROGRAM IS OPEN TO ALL Pag-IBIG I MEMBERS ONLY. 2. THE REGISTRATION UNDER THIS PROGRAM SHALL BE SOLELY A SAVINGS SCHEME. 3. THE MINIMUM CONTRIBUTION IS P500.00. 4. THE ANNUAL DIVIDENDS SHALL BE CREDITED TO MY ACCOUNT IN ACCORDANCE WITH

EXISTING HDMF POLICY. 5. THE MEMBERSHIP TERM SHALL BE FIVE (5) YEARS RECKONED FROM DATE OF INITIAL

PAYMENT OF CONTRIBUTIONS UNDER THIS PROGRAM. 6. UPON MATURITY, I SHALL RECEIVE MY TOTAL SAVINGS WITH DIVIDENDS.

7. UPON MATURITY, I MAY OPT TO RENEW FOR ANOTHER FIVE (5) YEARS. IF I DID NOT

WITHDRAW NOR RENEW UPON MATURITY, THE DIVIDEND RATE SHALL BE SUBJECT TO EXISTING HDMF POLICY.

8. IN CASE OF ANY CHANGE IN INFORMATION, I SHALL ACCOMPLISH THE MEMBER’S CHANGE OF INFORMATION FORM (MCIF) AND IMMEDIATELY NOTIFY HDMF.

I FURTHER CERTIFY UNDER PAIN OF PERJURY THAT THE INFORMATION GIVEN AND ANY OR ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT MY SIGNATURE APPEARING HEREIN IS GENUINE AND AUTHENTIC. ___________________________________________ ______________ SIGNATURE OF MEMBER OVER PRINTED NAME DATE

FOR HDMF USE ONLY

MP2 ACCOUNT NO.

FOR HDMF USE ONLY

MP2 ACCOUNT NO.

FPF096

FPF096

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