Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
REGIONAL OFFICE 6
New BFP Building, Block 19-A 4th Main Avenue, Phase 3,
Alta Tierra Village, Jaro, Iloilo City
Tel./Fax No. (033) 337-6918
Email: fcoc_r6@yahoo.com

PENSIONER’S UPDATE FORM

RETIREE

INSTRUCTION: Fill all applicable spaces legibly. Reproduction of this form is allowed.

Name _____________________________________ ________ Retired Rank ____________

Last Name First Name Middle Name Suffix

Present Address ____________________________________________________________ Region _________________

Date Retired ___________________ Amount of Pension _____________ ATM/Bank Account No. _________________

Date of Birth ___________________ Place of Birth __________________ Age _____ Gender _____ Civil Status _______

E-mail Address _______________________________________________ Contact No/s. _________________________

Beneficiaries Date of Birth Relationship

Attach 3R (3 ½ x 5 in.) full-body picture holding latest

newspaper of national circulation
(Add additional sheetwith the date clearly
if necessary)
FOR PENSIONER/SURVIVOR OFFICER USE ONLY.
shown, and two (2) valid IDs, such as Retiree’s ID,
DO NOT WRITE ON THIS PORTION
Driver’s License, Voter’s ID, PRC/IBP ID and Passport.
INSTRUCTION: Check/fill-out appropriate spaces:
If living abroad, provide red ribbon from consul.
1. Health Condition of Retiree
Ambulant ________ Incapacitated _______
2. Living Condition of Retiree
Local ____________ Abroad ____________
3. With own house? Yes _____ No ______
4. With illegitimate children? Yes _____ No ______

If Yes, pls. give details:

__________________________________________
__________________________________________
(Add additional sheet if necessary)

I hereby certify that I am the pensioner/survivor officer who

checked the veracity of updating Right
Left Thumbmark and Thumbmark
proof of life of this
pensioner/survivor.

______________________________ ________________
Name and Signature of Date
Pensioner/Survivor Officer

I hereby certify that the above information are true

and correct
Noted by: to the best of my knowledge and belief.

_________________________ ______________
______________________________ _________________
BFP-QSF-RBAS-025 Rev.00
Regional/Provincial Chief, RBS (04.19.23) Date
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
REGIONAL OFFICE 6
New BFP Building, Block 19-A 4th Main Avenue, Phase 3,
Alta Tierra Village, Jaro, Iloilo City
Tel./Fax No. (033) 337-6918
Email: fcoc_r6@yahoo.com

Signature over printed name Date

of Retiree

BFP-QSF-RBAS-025 Rev.00 (04.19.23)

 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
REGIONAL OFFICE 6
New BFP Building, Block 19-A 4th Main Avenue, Phase 3,
Alta Tierra Village, Jaro, Iloilo City
Tel./Fax No. (033) 337-6918
Email: fcoc_r6@yahoo.com

BFP-QSF-RBAS-025 Rev.00 (04.19.23)