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BS Form “B”

PAF AVIATION CADET AND OFFICER CANDIDATE ALUMNI ASSOCIATION, INC.


Colonel Jesus Villamor Air Base, Pasay City
Mil. Line 8745, Mobile Nr +63915-475-8575
E-mail: paf_aces@yahoo.com

_________________________
Date

Application for Additional PAFACAA Mutual Benefit System


I hereby apply for Additional PAFACAA MBS B:

1. RANK/FIRST NAME/MI/LAST NAME: _________________________________________________ AFSN:___________________

2. OFFICE ADDRESS: ______________________________________________________________________________________

3. PERMANENT ADDRESS: __________________________________________________________________________________

________________________________________________________________________________________________________

4. PAFFS/PAFOCS CLASS: ____________ DATE OF BIRTH: __________________TELEPHONE NR: ______________________

5. BENEFICIARY/BENEFICIARIES (Amount P50, 000.00)


(Specify the distribution of amount to the Beneficiaries)

a. Name Relation Amount

Address

b. Name Relation Amount

Address

c. Name Relation Amount

Address

d. Name Relation Amount

Address

e. Name Relation Amount

Address

7. MODE OF PREMIUM PAYMENT:


(Check one) ______ Monthly (P100.00) Payment for 7 years
______ Lump sum (P6, 000.00)
(Full payment or payment within 6 months)

___________________________________
Signature
MCard_______
PCard________
Certificate_____
Record_______
Access_______

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