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HE INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE ACCOMPLISHING THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY. PART I - TO BE FILLED OUT BY THE EMPLOYER A. EMPLOYER DATA EMPLOYER NUMBER TYPE OF EMPLOYER TAX IDENTIFICATION NUMBER BUSINESS HOUSEHOLD EMPLOYER NAME (RM./FLR./UNIT NO. & BLDG. NAME) ADDRESS (SUBDIVISION) TELEPHONE NUMBER (AREA CODE+TEL. NO.) (HOUSE/LOT & BLK. NO.) (BARANGAY/DISTRICT/LOCALITY) (CITY/MUNICIPALITY) MOBILE/CELLPHONE NUMBER (STREET N.

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