LORIMI Jeddah

Special Assistance - Death

Request Form
Preaching Point Information: Request Date: 05 DECEMBER 2023

Preaching Point Name: SOUTHWEST 5B - FCF

Overseer / Pastor: ADBER SANTOS Signature:

Treasurer: BENJU DE ROJAS Signature:

Approved by:

Network Leader: ISIDRO BUENSALIDA / JOAN BUENSALIDA Signature:

Special Assistance Request Data:

Requested by: PEDRO IBAY / ROSE AYA IBAY

Relationship: * MOTHER

ANACLETA CELEMIN
Name of Deceased:

Cause of Death: GASTRIC CANCER

Date Died: 26 NOVEMBER 2023

Address of Internment: QUEZON CITY and BATANGAS CITY

Contact Person: PEDRO IBAY

Contact Number: 058 337 8038

• The following are allowed: Member, Father, Mother, Legitimate Husband or Wife and Children.

Approved by Finance EXECOM:

Heinrich Varias Signature:

Tom Aquino Signature:

Jojo Edano Signature:

Note:
The Special Assistance – Death is a benefit given to a member who is at least 3 months or more as a regular and
active member of the PP/Sector.