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Office of the Vice Chancellor for Finance and Adminstration - Memorandum Issued for 2011
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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)
5
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
6
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
18
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
23
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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