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Republic of the Philippines Republic of the Philippines

Department of Education
Region IV-A
Department of Education
Region IV-A

SCHOOLS DIVISION OF QUEZON PROVINCE SCHOOLS DIVISION OF QUEZON PROVINCE

SURVIVORSHIP (DECEASED) SURVIVORSHIP (DECEASED)


Name: _________________________________ Name: _________________________________
District/School____________________________ District/School____________________________
GSIS Retirement Form (3 original) (long) GSIS Retirement Form (3 original) (long)
GSIS Application Form for Survivorship (3 original) (long) GSIS Application Form for Survivorship (3 original) (long)

Updated Service Record (1 original, 2 photocopy) Updated Service Record (1 original, 2 photocopy)
Approved Certificate of Last Payment (1 original, 2 Approved Certificate of Last Payment (1 original, 2
photocopy) photocopy)
Certficate of No Pending Case (3 original) Certficate of No Pending Case (3 original)
Clearance Form (CS Form No. 7 Revised 2018) (4 Clearance Form (CS Form No. 7 Revised 2018) (4
original) original)
District/School Clearance (3 original) District/School Clearance (3 original)
Division Clearance (3 original) Division Clearance (3 original)
Certificate of Termination of Account from Landbank (1 Certificate of Termination of Account from Landbank (1
original, 2 photocopy) original, 2 photocopy)
BIR 2316 (1 original, 2 photocopy) BIR 2316 (1 original, 2 photocopy)
Latest Payslip (1 photocopy) Latest Payslip (1 photocopy)
Latest Performance Rating Latest Performance Rating
Live birth, marriage certificate and death certificate Live birth, marriage certificate and death certificate
Special power of attorney Special power of attorney
DEPEDQUEZON-SDO-PER-04-074-000 DEPEDQUEZON-SDO-PER-04-074-000

Republic of the Philippines Republic of the Philippines


Department of Education
Region IV-A
Department of Education
Region IV-A

SCHOOLS DIVISION OF QUEZON PROVINCE SCHOOLS DIVISION OF QUEZON PROVINCE

SURVIVORSHIP (DECEASED) SURVIVORSHIP (DECEASED)


Name: _________________________________ Name: _________________________________
District/School____________________________ District/School____________________________
GSIS Retirement Form (3 original) (long) GSIS Retirement Form (3 original) (long)
GSIS Application Form for Survivorship (3 original) (long) GSIS Application Form for Survivorship (3 original) (long)

Updated Service Record (1 original, 2 photocopy) Updated Service Record (1 original, 2 photocopy)
Approved Certificate of Last Payment (1 original, 2 Approved Certificate of Last Payment (1 original, 2
photocopy) photocopy)
Certficate of No Pending Case (3 original) Certficate of No Pending Case (3 original)
Approved Certificate of Last Payment (1 original, 2 Approved Certificate of Last Payment (1 original, 2
photocopy) photocopy)
Certficate of No Pending Case (3 original) Certficate of No Pending Case (3 original)
Clearance Form (CS Form No. 7 Revised 2018) (4 Clearance Form (CS Form No. 7 Revised 2018) (4
original) original)
District/School Clearance (3 original) District/School Clearance (3 original)
Division Clearance (3 original) Division Clearance (3 original)
Certificate of Termination of Account from Landbank (1 Certificate of Termination of Account from Landbank (1
original, 2 photocopy) original, 2 photocopy)
BIR 2316 (1 original, 2 photocopy) BIR 2316 (1 original, 2 photocopy)
Latest Payslip (1 photocopy) Latest Payslip (1 photocopy)
Latest Performance Rating Latest Performance Rating
Live birth, marriage certificate and death certificate Live birth, marriage certificate and death certificate
Special power of attorney Special power of attorney
DEPEDQUEZON-SDO-PER-04-074-000 DEPEDQUEZON-SDO-PER-04-074-000

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