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    PFF351 ApplicationProvidentBenefitsClaimRTAV V03

    Uploaded by

    Geralyn Lava
    1) This document is an application form for a provident benefits claim from the Pag-IBIG Fund. It requests information such as the member and claimant's names, addresses, contact details, employer information, and bank account or disbursement card number to credit any approved claim proceeds. 2) The form has sections for the member's signature and date, computation of the amount due to the member including total contributions and dividends, and approval by Pag-IBIG Fund officers. 3) Upon receipt of the completed application, an acknowledgement section is filled out with the applicant's name, receiving officer's signature and date/time received.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PFF351 ApplicationProvidentBenefitsClaimRTAV V03

    Uploaded by

    Geralyn Lava
    1K views1 page
    1) This document is an application form for a provident benefits claim from the Pag-IBIG Fund. It requests information such as the member and claimant's names, addresses, contact details, employer information, and bank account or disbursement card number to credit any approved claim proceeds. 2) The form has sections for the member's signature and date, computation of the amount due to the member including total contributions and dividends, and approval by Pag-IBIG Fund officers. 3) Upon receipt of the completed application, an acknowledgement section is filled out with the applicant's name, receiving officer's signature and date/time received.

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    PFF351_ApplicationProvidentBenefitsClaimRTAV_V03

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    1) This document is an application form for a provident benefits claim from the Pag-IBIG Fund. It requests information such as the member and claimant's names, addresses, contact details, employer information, and bank account or disbursement card number to credit any approved claim proceeds. 2) The form has sections for the member's signature and date, computation of the amount due to the member including total contributions and dividends, and approval by Pag-IBIG Fund officers. 3) Upon receipt of the completed application, an acknowledgement section is filled out with the applicant's name, receiving officer's signature and date/time received.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views1 page

    PFF351 ApplicationProvidentBenefitsClaimRTAV V03

    Uploaded by

    Geralyn Lava
    1) This document is an application form for a provident benefits claim from the Pag-IBIG Fund. It requests information such as the member and claimant's names, addresses, contact details, employer information, and bank account or disbursement card number to credit any approved claim proceeds. 2) The form has sections for the member's signature and date, computation of the amount due to the member including total contributions and dividends, and approval by Pag-IBIG Fund officers. 3) Upon receipt of the completed application, an acknowledgement section is filled out with the applicant's name, receiving officer's signature and date/time received.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    HQP-PFF-351

    (V03, 11/2021)
    APPLICATION FOR PROVIDENT BENEFITS CLAIM
    (Release of Remaining Membership Savings
    or Residual Total Accumulated Value)

    INSTRUCTIONS
    1. Type or print all entries in BLOCK or CAPITAL LETTERS.
    2. Submit duly accomplished form together with photocopy of one (1) valid ID to any Pag-IBIG Branch nearest you.
    NAME OF MEMBER (Last Name, First Name, Name Extension, Middle Name) Pag-IBIG MID No.

    MEMBER’S PRESENT HOME ADDRESS MEMBER/CLAIMANT’S CONTACT


    DETAILS
    Home Tel. Number
    EMPLOYER/BUSINESS NAME

    Cell Phone Number


    EMPLOYER/BUSINESS ADDRESS

    NAME OF CLAIMANT (Last Name, First Name, Name Extension, Middle Name) AUTHORITY TO CREDIT
    IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR
    PROVIDENT BENEFITS CLAIM (Release of Remaining Membership Savings
    CLAIMANT’S PRESENT HOME ADDRESS or Residual Total Accumulated Value), I HEREBY AUTHORIZE Pag-IBIG
    FUND TO CREDIT MY CLAIM PROCEEDS TO MY PAYROLL
    ACCOUNT/DISBURSEMENT CARD THAT I HAVE INDICATED BELOW:
    PAYROLL ACCOUNT/DISBURSEMENT BANK’S ADDRESS
    CARD No.

    ________________________________ ______________
    SIGNATURE OF MEMBER/CLAIMANT DATE SIGNATURE OF MEMBER DATE
    OVER PRINTED NAME

    THIS PORTION IS FOR Pag-IBIG FUND USE ONLY


    FIRST RELEASE DATA
    CLAIM FILE NO. CHECK NO. DATE AMOUNT REMARKS

    COMPUTATION OF AMOUNT DUE TO MEMBER


    RECEIVED BY:
    DETAILS AMOUNT PAYABLE REMARKS

    EMPLOYEE’S/MEMBER’S TOTAL REVIEWED BY:


    CONTRIBUTION
    EMPLOYER'S TOTAL CONTRIBUTION
    TOTAL DIVIDEND EARNED APPROVED BY:
    TOTAL ACCUMULATED VALUE (TAV) ₱
    ____________________________________________________ ______

    ACKNOWLEDGEMENT RECEIPT
    FOR APPLICATION FOR PROVIDENT BENEFITS CLAIM
    (Release of Remaining Membership Savings or Residual Total Accumulated Value)
    Name of Member: (Last Name, First Name, Name Extension, Middle Name)

    Name of Claimant: (Last Name, First Name, Name Extension, Middle Name)

    Received by: Remarks:

    _____________________________________
    (Signatory Over Printed Name)
    Date: _____________ Time: __________

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