"ARMED FORCES AND POLICE SAVINGS & LOAN ASSOCIATION, INC. (tuetre bye toges svn ites ore bon sera nono i = a ‘i INSTRUCTIONS ee z 1. Read the information af the back before filing- out this form Basel pee 2. Rloul storm corscty, compete on ex. ey 3._Prinf all entries and check appropriate boxes. * epee PARTI. DECEASED PERSONNEL INFORMATION ates = 3 - TAT NAME TST AME cco TREFOSTON TRAIACEINO. | Powreunionse | sas C1 sige OC) mores widowed EI otnes Toe ADDRe Tete vos, stest _ Chnuniipctymoince ae cea DATE OF ‘DATE OF Gites Cl ina, Cliaccond 210 dyes Lil ones || SP Sg a a AGE OFDEATH nape Ads of ost ton ove No. Steet taney Cihniceainotce PARTIL CLAIMANTS INFORMATION TASTHANE FEST NAE MDE NAVE Taine tii Soe parca Conoco TaATORPTODECERO EMEC MI APSA Seeks Clete “Coin Ds saanset | declare under pain of petery tha! the foregoing information are true dnd comect to the best of my knowledge. | uncerstond that fasiication or misrepresentation of matericl information contained herein resuiling fo the oppreval of my cloims on behall of the deceased person will make me able under the lows. In cose the deceased member has ulsianding fancial obligations with AFPSLAL | hereby authorize AFPSLAI fe deduct the same from the fofal termination proceed. OI hereby request AFPSLAI to close the deceased person's accounts prior fo alvidend deciaration. In so doing, 1am waiving whatever dividends wil accrue to said accounts upon deciaration of dividend, L inerety request AFPSLAI to close the deceased person’s accounts after dividend declaration. thereby request AFPSLA) to transfer the balance of the JOINT account of deceased person where | am co-depositor to my ‘existing cecoun, subject To the rules and reavations of AFPSLAI on transferred account balances due fo death. understand that transfer shall be effected dung the ASwociation’s scheduled placement dotes ‘Claimant's Signature: Received by: Dole Received: Dote of Release: To Releasing Teller: Please require the t documents prior forelease of check: — TERMINATION CLAIM STUB (fo be filec-up by AFPSLAI Personnel) Nome of Cloimant Date Flo Name of Deceased: Claim Number: = = Received By: ee Nature of Clans als check os applicable} Toeking Reauirements ‘AIMS Clim 1 ‘} account Procaecs 2 Penson Account Proceeds 5 Pcie come bockon__at he Cheque Releasing Counter fo ccim he erinaion proceeds Moke sue o comply wih fackng (equlerents irany asc bang cheat 2 vaio a repvecentoive wit elaim he cheque, pieces cure a spac power of aamey ond present yok of ‘he Gimant and representative. Wereques! you cal ust ah [befre coming ¥9 AFPSLAL. Than youEEMINATION DUE 10 DEATH, TeMNanoreas Aareernent rogordess of omount ‘ecomplshed Termination Form NS0-cortiteg beat Confcare of Ceceoted Member or Death Cerca wth Regry Number Duly-noteraed aida of Undertaking ZNPSIA ID Pesbooks vai 0s of Cairront pReNe Without Survivorehip Agreement Capital Con co belay limember died single, proceeds will be automatically given fo the surviving parents: ltmember is married. proceeds will be automatically given to surviving spouse: "Accomplished Termination Form NSO-cerified Death Cerificate of Deceased Member or Death Cerificate with Registry Number AEPSLA 1D /Passbooks Duy-notorzed Affidavit of Undertaking 2valid IDs of Claimant Cerificate of Lega! Beneficiaries NSO-cerified proot of relationship of claimant to deceased member (Morriage Contactor Birth Certticate, os ‘ppliccbie} 1. Alreauirements stated under cecounts without sunvorship agreement above plus NSO-cerfied proof of relationship of all claimantsmets to the deceased member. If cicimanls ore married, present maniage contract or vali 10 containing moried name. 2. Optional requicement - Duly Notarized or Consulated (it heis reside abroad) Weiver of Righis from Other Legal Claimants in favor of one claimant alone supperted by authenticated coples of et least 2 val IDs of claimants who waived with legible signatures. 3. Affidevit of Guardianship Reauremenls 1-5 stated under accounts without survivorship agreement pus the folowing: 1. Cerificate of Refund of Pension from PYAO/Finance Center (transmitted by the PVAO/Finance Centers rect to AFPSLA 2. Decioration of Legal Beneficiaries/Decree of Final Distibution - opalicable only to AFP/PNP persion: no ‘need to suomi if the pension is rom PVAO. 3. Duly.notarized Affidavit of Guarcionship for Chiceen of Miner Age/s ALMS Claim 1. Investigation/Casvalty Repor/Rasio Message/tine of Duly Status Report for those who died in ine of duly 2 autiol Receipts, as necessary. ‘Special Reauirement 1. Cerificate of Last Payment from Finance Centers For active AFP/PNPBIMP/BFP civilian members with salary/EL/pension ‘ond thet cpolicable loon and automatic copited contribution remittances. 2. | Special Power of A'tomey - for ransaactions through Representctives Note: Additional requirements, as determined by the Branch Manager. may be required for complicated claimsi.e., “multiple Claimants, lock of cloimants, unclear identiy,efc. | Lost B/Passbooks must be covered by a nolorized Affidevi of Loss (ACL) which maybe obtained outside or from Legal Div. If obicined ‘Oulsde, ADL need not poss thu Legal Division. In both coies, signcture of member must always be verliod. 2 Valid inckides cepencent/miltary/ polce/ gensoner's IO, company ID, Senior zen Card, $55/GSI ID, votes ID, diver's license. passport. Inthe absence of vali IDs, Nal Clearance of other vaid lego! documents supporting his denty are acceptable. Postal ID ‘acceptable only if cloimant is unemployed \ Afidavit of Undertaking may be obicined oulside cr from Legol Divison. I states thal the account isthe only money left by the decedent he/she/they is/are the only hei: and he/shesthey wil indemnity the Association for whatever damage and wil keep the Association free ‘and harmless rom any labily far ony calr/s nat may be made later on by tne lego! hes. «Valid inekides cepencieni/miltary/ pollce/ pensoner's ID. company ID. Senior Ciizen Card, $88/GSI ID, votes ID, diver's license, passport. Inthe absence of vais Ds, Nal Clearance or otner valid lego! documents supporting his entity are acceptable. Postal ID ‘acceptable only if cleimant is unemployed. For AFP personnel, this is being sued by OTAG, For other personnel from the PNP. BJMP_and civiion employees, this moy be issued by their respective employer. For assaciote members, Cerifcate of Legal Beneficiaries may be obtained from previous employerin company letiethead. allemate requrementsin the absence thereof are GSS/SSS List of Beneficiaries