Employee Transfer Request Form (ETRF), ROASD-1768, Revision-0

Page No. Page 1 of 1 EMPLOYEE TRANSFER REQUEST FORM Form No. ROASD-1768 (ETRF) Revision No. Effectivity 0 June 22, 2026 Use this form to notify PAGCOR regarding the existing Manpower of the entity. Please accomplish this form by providing correct and complete information. The entity shall submit this form to ROASD, if the company opts to transfer employees assigned from a cancelled site to another operational site. Name of Company: Business/Site Address: Email Address: Authorized Representative: Contact Number: CLASSIFICATION OF POSITION EMPLOYMENT BIRTHDAY SEX DATE HIRED (Managerial, Supervisory, No. LAST NAME FIRST NAME MIDDLE NAME NATIONALITY REGISTRATION POSITION PREVIOUS SITE ASSIGNED DESIGNATED SITE LOCAL ADDRESS (MM/DD/YYYY) (M/F) (MM/DD/YYYY) Non-Supervisory, Non- NUMBER (ERN) Organic/Contractual) 1 2 3 l 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 27 28 29 30 INSTRUCTIONS: 1. All employees must be on the list (regular, contractual, probationary and under agencies). 2. All Filipino and foreign nationals should be properly documented. 3. Changes in format are not allowed. All fields should be properly filled out. 4. Dates must be encoded in month-day-year (Ex. April 30, 2026). 5. Accomplished ETRF report should be signed and notarized upon submission. (pdf and excel file) CERTIFICATION: This is to certify that the information provided herein has been carefully verified and found to be updated, accurate and complete. I understand that misdeclaration and incorrect information may lead to imposition of administrative penalties. Signature over Printed Name of Authorized Representative Date