PVAO-CBA-18-05

REPUBLIC OF THE PHILIPPINES

Department of National Defense
PHILIPPINE VETERANS AFFAIRS OFFICE 2” x 2”
Camp General Emilio Aguinaldo, Quezon City PASSPORT
SIZE
PICTURE
APPLICATION FOR OLD AGE PENSION (VETERAN)
(AFP RETIREE VETERAN)

(IMPORTANT: Please fill-up this form completely and submit the same together with the required documents listed herein.
Incomplete application will not be accepted.)

FAMILY NAME FIRST NAME MIDDLE NAME (LEAVE THIS SPACE BLANK)

CLAIM NO. :

COMPLETE ADDRESS (No./ St. Subd., Brgy./ District, Municipality/ City, Province) ENCODED BY:

DATE :

CONTACT NO.:
DATE OF BIRTH: PLACE OF BIRTH:

NAME OF LEGAL SPOUSE: DATE AND PLACE OF MARRIAGE:

RANK: SERIAL NO.: MAJOR SERVICE: NATIONALITY:

DATE OF RETIREMENT/ DISCHARGE: LAST UNIT OF ASSIGNMENT:

DOCUMENTARY REQUIREMENTS::
 Photocopy of AFP pensioner’s I.D. (Original must be presented) / OSCA I.D. / Driver’s License
 Retirement Order / Birth Certificate ( either issued by PSA or Local Civil Registrar)

DECLARATION OF APPLICANT

I declare that the information I have given in this application is truthful, complete and correct.
I understand that any false statements or concealment of information may result in the disapproval of my application.
I have not been discharged or separated from the military service under dishonorable conditions.
I am fully aware of the consequences of committing fraud in connection with this application.

In witness whereof, I have hereunto affixed my signature and thumbmarks this ____________ day of ____________ 20___.

THUMBMARKS
OF VETERAN ________________________________________________________
Applicant’s Signature over printed name
LEFT RIGHT

(This portion is to be filled-up by the PVAO Claims Examiner)

Review and evaluated by: _____________________________________________________

Date : _____________________________________________________

Note: This application form is made available FREE OF CHARGE by the Philippine Veterans Affairs Office. The same form is
made downloadable via PVAO website at www.pvao.gov.ph.

Rev 01 S. 2018