dpn RETIREE REQUEST FORM

OR No:___________________
*For Retiree / Representative only
Date : _____________
Name of Principal: ______________________________________________ SRRV No. __________
Last Name First Name Middle Name
___Male ___Female ___35 – 49 years old ___50 years old & Above

Address ( Local )_________________________________________________________________________

Address ( Abroad)________________________________________________________________________

Telephone No. : __________________________________ Fax :___________________________________

Mobile No. :__________________________________ E- Mail :___________________________________

Nature of Request ID Renewal Re – Stamping Others please specify : ______________________________

*To be filled-up by authorized representative

Name of Representative:
_____________________________________________________ ____________________________
Last Name First Name Middle Name Signature

Contact Details : ___________________________________________________________________________________

___Marketer ___SPA ___Authorization

* For RRSD STAFF only STAFF ACTION

Instructions: Action Officer

1. PRA ID Card : ___________________ Expiry Date Printed By:____________ ______________

month/year
2. Visitorial Fee : ___________________ Amount to be Paid Php $ ____________ ______________
month/day/year

3. Requisite Deposit Php $ __________________________ As of __________________________

4. Investment ___Condominium ___ Long Term Lease ___Golf Share ___Others _____________

5. Requirements ___CCT w/Restriction ___TCT w/Restriction ___MP ___Notarized Contract of

Lease
___GIS ___ATR ___SSS
___Phil Health ___FS ___Stock Certificate
___Deed of Sale ___Contract of Lease ___Golf Certificate _____________
Police Clearance: Complied Not Complied Not Required Waived
Other Receivables_______________________________________________________________________
Certified Correct: Noted by:
___________________________________ ___________________________________
OIC – Servicing Division / Investment Monitoring RRSD – Department Manager

ORDER OF PAYMENT
Date :___________________ Exchange Rate : $1.00 = PHP________________
Name of Principal :__________________________________________ SRRV No. __________________

Particulars Period Covered SRRV No(s). Amount

US $ PHP
ID Fee _____________ _____________ ____________ _____________
_____________ _____________ ____________ _____________
BI Fee(s):
- Re Stamping _____________ ____________ ____________
- Cancellation _____________ ____________ ____________
- Downgrading _____________ ____________ ____________
Service Fee(s):
- Re Stamping _____________ ____________ ____________
- Cancellation _____________ ____________ ____________
- Downgrading _____________ ____________ ____________
Visitorial Fee: _____________ ____________
Other Fee(s):
Please Specify: ________________

TOTAL AMOUNT
Processor: _______________________________ PAYABLE US$_____________ PHP______________
Date Accomplished: ________________________
TIME
Remarks: PAO __________
1. Request REQ __________
2. Verify Last ID IDV ___________
3. Verify Requisite Deposit/Investment FIN ___________
4. Documentary Compliance COMP_________
5. OIC Servicing DC ___________
6. Cashier CASH__________
7. Receipt of OR OR ___________
8. ID Printing IDR___________
PRA-SD-FORM-0006 Issue No.0002 Issue Date : April 2018 9. Release REL___________