Republic of the Philippines

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE
Quezon City
________________________
_____________________________
_____________________________
_____________________________
Si!M"#"$%
This is in connection &ith you cl"i$ fo #e"th benefits #ue the l"te
M'!Ms'_______________________________, ple"se funish this Office &ith the
follo&in( #ocu$ents%
1. Applic"tion fo Retie$ent effecti)e ___________________________;
2. Applic"tion fo Su)i)oship benefits*
3. Applic"tion fo +SIS C"sh Suen#e ,"lue!Te$in"tion ,"lue*
4. Cetifie# tue copy of #e"th cetific"te*
5. Cetifie# tue copy of $"i"(e cont"ct*
6. Cetifie# tue copy of bith cetific"te of chil#en*
7. Cetifie# tue copy of $"i"(e cont"ct of $"ie# fe$"le chil#en*
8. Affi#")it of -"i)e of Ri(hts* .option"l/
9. Applic"tion fo Te$in"l 0e")e &ith cl"i$"nt1s si(n"tue only*
10. N"tion"l Office Cle""nce*
11. Re(ion"l Office Cle""nce fo$ Re)enue Re(ion No' _____________________*
12. Cetific"te of l"st s"l"y ecei)e# fo$ the Chief2 Fin"nce Di)ision .Re)enue Re(ion
No' _______________________________/*
13. 3p#"te# Se)ice Reco# in the 4IR*
14. Se)ice Reco#s outsi#e the 4IR2 if "ny*
15. 4IR oi(in"l I#entific"tion c"#*
16. Copy of l"test "ppoint$ent*
17. St"te$ent of Assets2 0i"bilities "n# Net&oth effecti)e________________________;
18. Authoity to #e#uct "##esse# to the Chief2 Accountin( Di)ision2 4IR2 Quezon City*
19. Cetific"tion fo$ the 0"n# 4"n5 of the Phils'2 4"nch M"n"(e th"t you "e "n
e6istin( #eposito of th"t b"n5* .option"l/
20. Applic"tion fo e6tension of 4IRMA+ $e$beship*
21. Applic"tion fo Po)i#ent 4enefits .PA+7I4I+/*
22. Accountin( e8uie$ents*
23. Tun7o)e of $oney "n# popety "ccount"bilities .nee#e# by Popety Di)ision/*
"n#
24. Co$$ission on Au#it .COA/ Settle$ent'
9ou $"y #iectly in8uie fo$ the follo&in( Di)isions!Offices e% "ccount"bilities fo "n
e"ly settle$ent theeof'
:' Popety Di)ision ;' Re)enue Accountin( Di)ision
<' Account"ble Fo$s Di)ision =' 4IRSA0A
Ple"se be info$e# th"t the e8uest fo fun#in( &ith D4M M"l"c">"n( sh"ll be
pep"e# only upon co$pletion of the e8uie# #ocu$ents'
,ey tuly yous2
BENILDA M. CARAIG
OIC7Chief2 Pesonnel Di)ision
4y%
MENCIE A. FRE!CO
Chief2 Co$pens"tion ? 4enefits Section
Pesonnel Di)ision
M7:%$"f%el