This document is a GSIS Member's Request Form (MRF) which collects information from members such as name, date of birth, gender, civil status, GSIS account details, type of request, and nature of request. Members must fill out the form correctly and submit it to the nearest GSIS Office to process their request.
This document is a GSIS Member's Request Form (MRF) which collects information from members such as name, date of birth, gender, civil status, GSIS account details, type of request, and nature of request. Members must fill out the form correctly and submit it to the nearest GSIS Office to process their request.
This document is a GSIS Member's Request Form (MRF) which collects information from members such as name, date of birth, gender, civil status, GSIS account details, type of request, and nature of request. Members must fill out the form correctly and submit it to the nearest GSIS Office to process their request.
This document is a GSIS Member's Request Form (MRF) which collects information from members such as name, date of birth, gender, civil status, GSIS account details, type of request, and nature of request. Members must fill out the form correctly and submit it to the nearest GSIS Office to process their request.
INSTRUCTIONS: Ensure that the request form is properly filled out and submitted to the nearest GSIS Office.
WARNING: Directorindirectcommission of fraud, collusion, falsification, misrepresentation of facts, orany otherkind of anomaly in the accomplishment of this form, as well as obtaining any benefit pursuant to this request shall be subject to administrative, civil and/or criminal action. THIS FORM lS NOT FOR SALE.
Date: Last Name First Name Middle Name Suffix
Date Of Birth trnvoorwwl Gender CivilStatus GSIS Business Partner (BP) No.
Mailing Address Zip Code
Agency Name and Address
Mobile Number EmailAddress Landline Number
lnstruction: P/ease check the transaction and indicate the
GSIS Accounts Claim Transaction Type of Account Type of Claim
E OS|S Premium Contributions I tr/taturity
E osts Loan/s f, Cash Surrender Value (CSV)/ Termination Value (TV) I wutti-Purpose Loan (lt/PL) tr Death Claim I Consolidated Loan (CNL) n RetiremenU Separation a GSIS Financial Assistance Loan (GFAL) Funeral Benefit n GFAL Educational Loan Survivorship n Emergency Loan (EML) Pre-need Policy Loan tr Edu-Child Others: tr College Education Assurance Plan (CEAP) Memorial Nature of Request: E oftrers E Reconciliation of GSIS Premium Contributions (Please attach Service Record) Employees' Compensation (EC) E Statement of Loan Account (SOLA) E others El-Certification of Full Payment (CFP) Nature of Request: E csts clearance I Payment of Benefit RA 8291 (Future Payee) E Certificate of No Loan/ Loan Balance I Recomputation of GSIS Benefit E Transfer of Claim ChecUs to preferred Branch I Payment of Benefit (under Pre-need) Details: E Payment of Benefit (under EC) I others: Details I others:
Other Transactions Details of Request: UtL (n$,8 cFpnfluTl Dil 0r flr\tvArl lvlFrr
I confirm my understanding of the Privacy Policy of fhe GS/S pursuant to the requirements of Republic Act (R.A.) No. 10173, otherwise known as the Data Privacy Act, and consent to the manner of collection, use, access, disclosure and processing of my personalandSenSitiVeperSonaldatabyfheGS/S,relativetotherequj|
Thumb mark Printed Name and Signature of Witnesses to
Civil Cover Sheets TUESDAY February 11th, 2025 in the Lancaster Court of Common Pleas Preliminary Emergency Injunction for Relief STAN J. CATERBONE v. Direct Express
