Philhealth Retirement Form PDF Details

Are you nearing retirement? Are you planning to receive your PhilHealth benefits after you retire? If so, then it is essential that you know how to properly file the right forms. To ensure that you are able to secure your full and rightful Philhealth compensation upon retirement, having a comprehensive knowledge of the different application processes as well as what documents must be included in such applications can certainly prove useful. Fortunately, this blog post covers the overview of steps from preparing for filing up until its completion – providing an informative guide designed to help those seeking crucial information about their PhilHealth Retirement Form.

QuestionAnswer
Form NamePhilhealth Retirement Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespag ibig retirement claim, pag ibig form for retirement, pag ibig provident claim form 2021, pagibig retirement claim requirements

Form Preview Example

APPLICATION FOR PROVIDENT

BENEFITS (APB) CLAIM

APPLICATION No.

REASON FOR CLAIM (Check appropriate box)

MEMBERSHIP MATURITY

SEPARATION FROM SERVICE DUE

OPTIONAL WITHDRAWAL

TO HEALTH REASONS

RETIREMENT

TOTAL DISABILITY/INSANITY

Effective Date of Retirement ____________

Nature of Illness ______________

Last Day of Service _____________________

 

PERMANENT DEPARTURE FROM

OTHERS

THE COUNTRY

Please Specify ______________

DEATH

 

Date of Death ______________

 

MEMBERSHIP PROGRAM (Check appropriate box)

 

Pag-IBIG I

 

 

Pag-IBIG II

 

MODIFIED Pag-IBIG II (MP2)

 

Pag-IBIG OVERSEAS PROGRAM (POP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEMBER’S PERSONAL DETAILS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., II) MIDDLE NAME

 

DATE OF BIRTH (mm/dd/yyyy)

 

Pag-IBIG MID No./RTN

TIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MOTHER’S LAST NAME BEFORE MARRIAGE (For Married Female Only)

 

 

MARITAL STATUS

 

SERIAL/BADGE No.

 

 

 

DIV.CODE-STATION CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

(For AFP/PNP Employee)

(For Dep.Ed. Employee)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLAIMANT, if other than Member (Last Name, First Name, Name Extension, Middle Name)

 

 

 

 

 

 

RELATIONSHIP TO MEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS AND CONTACT DETAILS

 

 

 

 

 

 

 

 

MEMBER’S PRESENT HOME ADDRESS

 

 

 

 

 

 

 

 

 

CONTACT DETAILS (Indicate country code if abroad)

Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No. House No.

Street Name

 

 

Subdivision

 

 

COUNTRY + AREA CODE

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Barangay

Municipality/City

Province/State/Country (if abroad)

 

 

 

 

 

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cell Phone

 

 

 

 

 

CLAIMANT’S PRESENT HOME ADDRESS (Leave blank if the same as member)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unit/Room No., Floor

Building Name

Lot No., Block No., Phase No. House No.

Street Name

 

 

Subdivision

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address

 

 

 

 

 

Barangay

Municipality/City

Province/State/Country (if abroad)

 

 

 

 

 

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)

 

 

 

NAME OF EMPLOYER/BUSINESS

 

ADDRESS

 

 

 

 

 

 

 

DATE OF Pag-IBIG MEMBERSHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM (Month/Year)

 

 

 

TO (Month/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUTHORITY TO CREDIT

 

 

 

 

 

 

AUTHORITY TO TRANSFER

 

 

 

 

 

 

 

 

(For matured savings under Pag-IBIG II/Pag-IBIG Overseas Program)

 

 

 

 

 

 

 

 

 

 

 

 

 

IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR PROVIDENT BENEFITS CLAIM, I

 

 

 

IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR PROVIDENT BENEFITS

 

HEREBY AUTHORIZE HDMF TO CREDIT MY CLAIM PROCEEDS THROUGH MY LANDBANK

 

 

 

CLAIM, I HEREBY AUTHORIZE HDMF TO TRANSFER

MY CLAIM PROCEEDS TO MY MP2

 

ACCOUNT OR CASH CARD THAT I HAVE INDICATED BELOW:

 

 

 

 

 

ACCOUNT THAT I HAVE INDICATED BELOW:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LANDBANK ACCOUNT/CASH CARD NO.

BANK’S ADDRESS

 

 

 

 

 

MP2 ACCOUNT NO.

 

 

AMOUNT TO BE TRANSFERRED

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Amount

 

Partial Amount P_________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF MEMBER

 

DATE

 

 

 

 

 

SIGNATURE OF MEMBER

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICATION AGREEMENT

I HEREBY CERTIFY THAT I HAVE READ AND UNDERSTOOD THE CONTENTS HEREOF, INCLUDING THE GUIDELINES AND INSTRUCTIONS INDICATED AT THE BACK PORTION OF THIS FORM. I FURTHER CERTIFY UNDER PAIN OF PERJURY THAT ALL INFORMATION I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, AND THAT MY SIGNATURE AND THUMBMARK ARE GENUINE AND AUTHENTIC. I LIKEWISE UNDERSTAND THAT THE PROCESSING OF THIS APPLICATION IS SUBJECT TO PERTINENT PROVISIONS OF THE IMPLEMENTING RULES AND REGULATIONS OF THE Pag-IBIG FUND. IN THE EVENT OF ANY OUTSTANDING Pag-IBIG LOAN, Pag-IBIG FUND IS HEREBY AUTHORIZED TO WITHHOLD, IN WHOLE OR IN PART, THE PROVIDENT BENEFIT SUBJECT OF THIS CLAIM, AND APPLY THE SAME AS PAYMENT TO THE SAID LOAN AS WELL AS OTHER OBLIGATIONS DUE TO THE Pag-IBIG FUND AS OF THE DATE OF THIS APPLICATION.

I HEREBY WAIVE MY RIGHTS UNDER R.A. NO. 1405 AND AUTHORIZE Pag-IBIG FUND TO VERIFY/VALIDATE MY PAYROLL BANK ACCOUNT NUMBER.

__________________________________

THUMBMARKS OF MEMBER/CLAIMANT

(If unable to sign)

LEFT THUMB

 

RIGHT THUMB

 

 

 

(To be done in the presence of HDMF Personnel)

MEMBER/CLAIMANT

_______________________________

_______

(Signature over Printed Name)

(Signature over Printed Name of Witness )

Date

 

THIS PORTION IS FOR HDMF USE ONLY

RECEIPT OF APPLICATION

RECEIVED BY

DATE

REMARKS

CLAIMS/LOAN VERIFICATION

PARTICULARS

WITH

WITHOUT

 

DETAILS

 

VERIFIED BY

DATE

PROVIDENT BENEFITS CLAIM

 

 

DV/CHECK NO.

 

DATE FILED

 

 

 

Pag-IBIG LOANS AVAILED

DV NO.

CHECK NO.

OUTSTANDING BALANCE

AS OF

 

 

MULTI-PURPOSE/CALAMITY LOAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HL ACCOUNT NO.

TAKEOUT DATE

OUTSTANDING BALANCE

AS OF

 

 

HOUSING LOAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYEE/S

 

 

 

 

 

 

REMARKS

 

 

 

 

 

 

 

 

 

 

COMPUTATION OF AMOUNT DUE TO MEMBER

DETAILS

AMOUNTS PAYABLE

REMARKS

COMPUTED BY

DATE

 

 

 

 

 

 

 

 

EMPLOYEE'S/MEMBER'S TOTAL CONTRIBUTION

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S TOTAL CONTRIBUTION

 

 

 

 

 

 

 

 

 

 

 

TOTAL DIVIDENDS EARNED

 

 

 

REVIEWED BY

DATE

 

 

 

 

 

 

 

 

 

 

 

TOTAL ACCUMULATED VALUE (TAV)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LESS: OUTSTANDING LOAN BALANCE

 

 

 

APPROVED BY

DATE

 

 

 

 

 

 

 

 

 

 

 

NET AMOUNT

 

 

 

 

 

 

 

 

 

 

DEATH BENEFIT

 

 

 

DISAPPROVED BY

DATE

 

 

 

 

 

TOTAL AMOUNT DUE TO MEMBER

THIS FORM MAY BE REPRODUCED. NOT FOR SALE

(Revised 03/2011)

GUIDELINES AND INSTRUCTIONS

A.When to File

The Application for Provident Benefits Claim (APB [FPC010]) may be filed upon the occurrence of any of the following:

1.Membership Maturity - a period of not less than 20 years commencing from the 1st day of the month to which the member's initial contribution to the Fund applies, provided that the member has actually contributed a total of 240 monthly contributions to the Fund at the time of maturity;

2.Optional Withdrawal of Pag-IBIG Savings - allowed for members who registered under R.A. No. 7742, as well as members who voluntarily joined the Fund under E.O. No. 90.

Partial withdrawal of savings may be made after 10 or 15 years of continuous membership from January 1995. For members who registered under R.A. No. 9679 shall have the option to withdraw his or her Total Accumulated Value (TAV) on the fifteenth (15th) year of continuous membership. Provided, a member has no outstanding loan with the Fund. This option may be exercised only once during the membership term.

3.Retirement – a member shall be compulsorily retired under the Fund upon reaching age sixty-five (65). He may, however, opt to retire earlier under the Fund upon the occurrence of any of the following:

a.his actual retirement from the SSS, GSIS or separate employer provident/retirement plan, provided, however, that under the latter case, the member has at least reached age forty-five (45).

b.notwithstanding his continued employment or service, upon reaching age sixty (60), provided he is not a member-borrower;

4.Total Disability or Insanity – loss or impairment of a physical or mental function resulting from injury or sickness which completely incapacitates a member to perform any work or engage in any business or occupation as determined by the Fund;

5.Separation from the service due to health reasons;

6.Permanent Departure from the Philippines;

7.Death.

B.Who May File

The application may be filed by the member, his guardian, or any authorized representative/s. If the reason for claim is death of the member, the application may be filed by his beneficiary/ies or the latter’s representative/s, or any appointed court administrator or executor.

In all instances wherein Application for Provident Benefits (APB) Claim is filed by an authorized representative, the Special Power of Attorney (FPC014) and the identification cards of both the member and his/her representative/s shall be presented and/or submitted.

C.Payment of Benefits

1.Amount

The Provident Benefits of a member shall consist of his Total Accumulated Value (TAV), which includes the member’s personal contributions to the Fund, his employer’s counterpart contribution, if applicable, and the dividend earnings of the total contributions declared by Pag-IBIG Fund.

2.Application of TAV

In the event of membership termination, the outstanding balance of the member’s Short-Term Loan (STL) shall be deducted from his TAV. Likewise, the outstanding balance of the member’s housing loan shall be deducted from his TAV, unless the guidelines prevailing at the time of loan takeout provided otherwise.

Borrower/s who opt to continue amortizing the housing loan balance shall be required to continue paying the monthly membership contribution in accordance with the terms and conditions of the Promissory Note or Loan and Mortgage Agreement (PN/LMA) until the loan obligation is fully settled.

For accounts taken out under the UHLP Multi-Window Lending System, the following shall apply:

a.Upon termination of the borrower’s membership which entitles him to the benefits as provided for under the rules of the SSS, GSIS, and Pag-IBIG, the TAV to be received by the borrower shall be applied to his outstanding housing loan.

In case of death, the provision of the borrower’s Mortgage Redemption Insurance (MRI) shall apply, and if an unpaid balance remains, the borrower’s TAV or death benefits shall be applied in payment thereof, subject to the existing policies, rules and regulations.

b.Upon the occurrence of an event of default, the lending window or its assignee/transferee may apply any of the borrower’s funds in the possession of the lending window or its assignee/transferee in full or partial payment of the borrower’s obligations as stated in the LMA and Promissory Note.

For this purpose, the LMA provides further that the borrower authorizes the lending window or its assignee/transferee to secure and apply without prior notice to the borrower any fund belonging to him in the possession or control of the lending window or its assignee/transferee.

3.Manner of Payment

For claims due to membership maturity, the benefits shall be paid either by check directly to the member or deposited to the member’s payroll bank account.

For claims other than membership maturity, the benefits shall be made directly to the member, his guardian or any authorized representative, provided that, in the event of death of a member, payment shall be made to his beneficiary/ies or the latter’s guardian/authorized representative/s, or any duly appointed court administrator or executor.

Should there be any contribution due the member but not yet received by the Fund at the time of the above payment, the same shall be correspondingly released after receipt of the unremitted contributions.

LIST OF REQUIRED DOCUMENTS

 

REQUIREMENTS

MM

OW

R

SS

TD

PD

D

Remarks

1.

Notarized Certificate of Early Retirement (For Private Employee, at least 45 years old)

 

 

X

 

 

 

 

 

2.

Updated Service Record (For Government Employee)

X

X

X

X

X

 

 

 

3.

Any of the following: (For Private/Government Employee)

 

 

X

 

 

 

 

 

National Statistic Office (NSO) Certified True Copy of Member’s Birth Certificate*

SSS Retirement Voucher (For Private Employee)/GSIS Retirement Voucher (For Government Employee)

Valid ID card with photo and signature or 2 valid ID cards stating date of birth

4.

Order of Retirement

 

 

 

X

 

 

 

 

5.

Updated Statement of Service

(For AFP, Phil. Navy & Phil. Army personnel)

X

 

X

 

 

6.

Statement of Last Payment

 

 

X

 

X

7.

Physician’s Certificate/Statement

 

 

X

 

 

 

8.

Notarized Sworn Employer’s Certification that the Member was separated from service due to health

 

X

 

reasons

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

Latest SSS Disability Voucher (For Private Employee)

 

X

 

 

 

10.

Physician’s Certificate or Statement of Insanity

 

 

X

11.

SSS Total Disability Voucher

 

 

 

X

 

 

12.

Compulsory Disability Discharge (CDD) Order (For AFP, Phil. Navy & Phil. Army Personnel)

 

 

X

13.

Photocopy of Passport

 

 

 

 

 

 

X

 

14.

Notarized Sworn Declaration of Intention to Depart from the Philippines Permanently [FPC013]

 

 

 

X

15.

Any of the following:

 

 

 

 

 

 

X

 

 

Immigrant Visa;or

Settlement Visa; or

 

 

 

 

 

 

Residence Visa; or

Such other equivalent document depending on the issuing country

 

 

 

 

 

16.

NSO Certified True Copy of Member’s Death Certificate

 

 

 

 

X

17.

Notarized Proof of Surviving Legal Heirs [FPC011]

 

 

 

 

X

18.

To establish kinship to the deceased member, the claimant shall submit any of the following:

 

 

 

 

X

NSO Certified True Copy of Member’s/Claimant’s Birth Certificate; or

NSO Certified True Copy of Member’s Marriage Contract (If member is married); or

Certified True Copy of Member’s/Claimant’s Baptismal/Confirmation Certificate

Certificate of No Marriage (CENOMAR) (For Single Only)

19.

NSO Certified True Copy of Birth Certificate* of all Children (if any) or Baptismal/Confirmation Certificate

 

 

 

 

 

 

X

20.

Notarized Affidavit of Guardianship (For children 18 years old and below, or physically/mentally incompetent)

 

 

 

 

 

 

X

 

[FPC012]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.

Funeral Receipt

 

 

 

 

 

 

X

22.

Two (2) valid ID cards with signature and photo of claimant

X

X

X

X

X

X

X

23.

POP Passbook (For POP Members only)

X

 

 

 

 

 

 

24.

Special Power of Attorney [FPC014] (If member cannot claim personally)

X

X

X

X

X

X

 

25.

Certification of Foreclosure/Dacion En Pago issued by the Foreclosure Department (If applicable)

 

 

 

 

 

 

 

26.

*NSO Certified True Copy of Non-Availability of Birth Record of Member together with any of the ff:

 

 

X

 

 

 

X

Notarized Joint Affidavit of Two (2) Disinterested Persons [FPC015]; or

Photocopy of two (2) valid ID cards or any document indicating member’s date of birth 27.Others

Pag-IBIG Fund reserves the right to request additional documents if deemed necessary.

IMPORTANT:

1.PROCESSING OF CLAIMS WILL COMMENCE ONLY UPON SUBMISSION OF COMPLETE DOCUMENTS.

2.IN ALL INSTANCES WHEREIN PHOTOCOPIES ARE SUBMITTED, THE ORIGINAL DOCUMENTS SHALL BE PRESENTED FOR AUTHENTICATION.

LEGEND:

MM

-

Membership Maturity

R

-

Retirement

TD

-

Total Disability/Insanity

 

OW

-

Optional Withdrawal

SS

-

Separation from the Service Due to Health Reason

PD

-

Permanent Departure from the country

 

 

 

 

 

 

 

D

-

Death

How to Edit Philhealth Retirement Form Online for Free

You could fill out pag ibig retirement claim online application effectively by using our PDFinity® online tool. Our tool is constantly evolving to give the best user experience possible, and that's because of our commitment to continuous development and listening closely to customer comments. To begin your journey, consider these easy steps:

Step 1: Press the "Get Form" button in the top area of this webpage to get into our editor.

Step 2: The editor will give you the opportunity to modify the majority of PDF forms in many different ways. Improve it by adding your own text, correct what's already in the file, and put in a signature - all manageable within a few minutes!

For you to finalize this document, make sure you provide the information you need in each blank:

1. When filling in the pag ibig retirement claim online application, be sure to include all needed blank fields within its relevant part. This will help facilitate the process, allowing your details to be handled promptly and accurately.

Guidelines on how to complete pag ibig retirement form step 1

2. Once this segment is completed, you have to add the essential specifics in NAME OF EMPLOYERBUSINESS, ADDRESS, AUTHORITY TO CREDIT, DATE OF PagIBIG MEMBERSHIP, FROM MonthYear, TO MonthYear, For matured savings under PagIBIG, AUTHORITY TO TRANSFER, IN THE EVENT OF THE APPROVAL OF MY, IN THE EVENT OF THE APPROVAL OF MY, LANDBANK ACCOUNTCASH CARD NO, BANKS ADDRESS, MP ACCOUNT NO, AMOUNT TO BE TRANSFERRED, and cidcidcidcid Partial Amount P in order to progress to the next part.

BANKS ADDRESS, ADDRESS, and For matured savings under PagIBIG in pag ibig retirement form

Always be very attentive while completing BANKS ADDRESS and ADDRESS, since this is the section in which many people make a few mistakes.

3. Completing PARTICULARS, WITH WITHOUT, PROVIDENT BENEFITS CLAIM, PagIBIG LOANS AVAILED, MULTIPURPOSECALAMITY LOAN, CLAIMSLOAN VERIFICATION, DVCHECK NO, DETAILS, DATE FILED, DV NO, CHECK NO, OUTSTANDING BALANCE AS OF, HOUSING LOAN, PAYEES, and HL ACCOUNT NO TAKEOUT DATE is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Writing segment 3 of pag ibig retirement form

Step 3: Revise all the information you have typed into the blank fields and then click the "Done" button. Try a 7-day free trial option with us and gain direct access to pag ibig retirement claim online application - download, email, or change inside your FormsPal cabinet. FormsPal ensures your data privacy with a secure system that never records or shares any type of sensitive information used. Be assured knowing your paperwork are kept protected whenever you work with our services!

Philhealth Retirement Form isn’t the one you’re looking for?

Related Documents