Employment Registration Number (ERN) - Renewal Form (Form B), ROASD-1770, Revision-0

Page No. Page 1 of 1 EMPLOYMENT REGISTRATION NUMBER (ERN) Form No. ROASD-1770 RENEWAL FORM – FORM B Revision No. 0 Effectivity June 22, 2026 PART A. GENERAL INSTRUCTIONS 1. Use this form to signify intent to apply Filipino and Foreign employees to secure an Employee Registration Number (ERN). 2. Changes in format are not allowed and all fields should be properly filled out. 3. Dates must be encoded in month-day-year (Ex. July 10, 2024). 4. If the information required is not applicable, write "N/A". 5. All requirements should be submitted in digital copy. 6. Applications with incomplete information / requirements will not be accepted. PART B. REQUIRED ATTACHMENTS / SUPPORTING DOCUMENTS For Filipino Applicants: For Foreign Applicants: 1. PSA-certified birth certificate 1. Passport Bio page 2. Valid NBI Clearance 2. Valid National Police Clearance 3. Valid National Police Clearance 3. Valid work visa and permit 4. Tax Identification Number (TIN) 4. Tax Identification Number (TIN) 5. 2x2 I.D. photo (white background) 5. 2x2 I.D. photo (white background) PART C. APPLICATION DETAILS Date: ____________________________________________________________________________________ Name of Company: ____________________________________________________________________________________ Business/ Site Address: _____________________________________________________________________________________ BIRTHDAY DATE HIRED PASSPORT AEP 9(G) VISA VISA LAST NAME FIRST NAME MIDDLE NAME NATIONALITY POSITION TYPE OF VISA TIN # (MM/DD/YYYY) (MM/DD/YYYY) NO. NUMBER NUMBER VALIDITY 1 2 3 4 5 6 7 8 9 10 TOTAL: PART D. 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. PART E. NAME OF DECLARANT (to be filled-up by Authorized Representative) Printed Name: Contact #: Position E-mail Add: Signature