VETERANS FEDERATION OF THE PHILIPPINES

Gatpuno Villegas St., Ermita, Manila

ADDITIONAL HEALTH CARE ASSISTANCE

(Please see requirements at the back before filling out this form)

______________________________________________________________________

Name of Member/Applicant (Last Name) (First Name) (Middle Name)

Address ( Street) (Town City) PROVINCE ZIP CODE_________

Cellphone Number Date of Birth:

Date of confinement/Quarantine Date of Discharge

Veterans Post Membership Status

Veterans District Veterans Region____________________

VFP Membership ID card No. AFP Retirement ID card No._________________

CERTIFICATION AND SIGNATURE (READ CAREFULLY BEFORE SIGNING)

I HEREBY CERTIFY that:

1. The foregoing entries and attached supporting documents are true and correct.
2. I am fully aware of the consequences of committing fraud in connection with this application.

In witness whereof, I have hereunto affixed my signature this__________day of ________________

year 20 ______.

Signature: __________________________________________
Applicant

Valid ID With No. ___________________________________

I HEREBY CERTIFY and endorsed that the member/recipient is a member in good standing and
all the documentary requirements submitted by the applicant as listed in the application are
authentic.

__________________________________________
Signature of over Printed name of
Charter/Affiliate/Post President
 INSTRUCTIONS:

1. Eligibility:

a. To avail of this program a veteran-member shall be in good standing. A veteran-member in good

standing is one who complies with the duties and a responsibility prescribed by the VFP, to include
payment of membership dues, and does not perform acts which are derogatory and inimical to the
integrity and interest of the VFP.

b. The member was afflicted and found to be positive of Covid 19 disease at the start of the pandemic
outbreak in 2020.

c. Only those living members afflicted by Covid-19 are eligible beneficiaries.

d. Members may only avail this benefit once a year.

2. Filing of Application - The member must file/submit the application together with the original documentary
requirements to the VFP National Headquarters or Charter/Affiliate/Post Presidents where he applied and
registered his application for membership.

3. Documentary Requirements:

a. Duly accomplished application form signed by the member.

a. Original copy of Swab Test Result certified by licensed Covid-19 Testing Laboratories in the
Philippines that the member was positive with SARS Covid -19.

c. Original copy of Medical Certificate issued by hospital Physician that the member was admitted for
confinement in the hospital or Certificate of Quarantine issued by Municipal/City Health Officer that the
member has undergone the quarantine in the mandatory facility and clinically recovered with the Covid-
19.

d. Photocopy of VFP membership ID card and AFP Retirement ID card if member patient is a veteran.

e. Photocopy of VFP membership ID card and PVAO Pensioner ID card if member patient is a surviving
spouse of veteran.
f. Photocopy of valid ID and 3 specimens signature of the applicant/claimant.

3. Mode of Payment :

The Additional Healthcare Assistance in the amount of P10,000.00 shall be paid directly to member-
recipient who apply for additional health care assistance thru check or ATM savings account upon
submission of application and the original documentary requirements to the VFP National
Headquarters.

4. Duties and Responsibilities of the Charter, Affiliate and Post Presidents:

a. Shall certify by way of endorsing the application that the member/recipient is a member in good standing
and all the documentary requirements submitted by the applicant as listed in paragraph 3 are authentic.

b. Shall scan/take picture the application and the documentary requirements and send directly through
any of the following electronic communications: VFP Official Website; E-Mail; Messenger for validation and
facilitate the processing of the application.

Received and Verified by:

Reviewed and Recommended by:

Approved by: COMMO SALVADOR Q. ESGUERRA AFP (RET)

Vice President for Operations