PAGCOR Forms ROASD-1645ROASD-1645
Remittance Form, ROASD-1645, Revision-0
Page No. Page 1 of 1 Form No. ROASD-1645 REMITTANCE FORM Revision No. 0 Effectivity Jun. 22, 2026 Reference No. (Refer to the Deposit Notice and Payment Form) Settlement Date Name of Payor Company Name Signature Contact Number Email Address Amount Settled Particulars Please attach the proof/s of payment (validated deposit slip or validated wire transfer form):
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