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    DBC Application Form PDF

    Uploaded by

    James Abetok
    This document is an application form for claiming the death benefit of a deceased barangay official. It requests information such as the name, position, place of service, and dates of election/appointment and death of the barangay official. The claimant must sign and date the form, and attach certified copies of the death certificate, birth/marriage certificate, and affidavit of waiver or quit claim when applicable.

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    DBC Application Form PDF

    Uploaded by

    James Abetok
    289 views1 page
    This document is an application form for claiming the death benefit of a deceased barangay official. It requests information such as the name, position, place of service, and dates of election/appointment and death of the barangay official. The claimant must sign and date the form, and attach certified copies of the death certificate, birth/marriage certificate, and affidavit of waiver or quit claim when applicable.

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    DBC-Application-Form (1).pdf

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    This document is an application form for claiming the death benefit of a deceased barangay official. It requests information such as the name, position, place of service, and dates of election/appointment and death of the barangay official. The claimant must sign and date the form, and attach certified copies of the death certificate, birth/marriage certificate, and affidavit of waiver or quit claim when applicable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    289 views1 page

    DBC Application Form PDF

    Uploaded by

    James Abetok
    This document is an application form for claiming the death benefit of a deceased barangay official. It requests information such as the name, position, place of service, and dates of election/appointment and death of the barangay official. The claimant must sign and date the form, and attach certified copies of the death certificate, birth/marriage certificate, and affidavit of waiver or quit claim when applicable.

    Copyright:

    © All Rights Reserved
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    of 1

    DILG-NBOO

    DBC Form 001

    APPLICATION FOR BARANGAY OFFICIAL’S DEATH BENEFIT CLAIM

    Instructions: This form shall be accomplished by the claimants and submitted immediately to the DILG
    HUC/ICC/CC/Municipal Office.

    NAME OF BARANGAY OFFICIAL: ______________________________________


    POSITION: ______________________________________
    BARANGAY: ______________________________________
    CITY/MUNICIPALITY: ______________________________________
    PROVINCE: ______________________________________
    DATE OF ELECTION/APPOINTMENT: ______________________________________
    DATE OF DEATH: ______________________________________

    ________________________________________
    SIGNATURE OVER PRINTED NAME OF CLAIMANT

    _________________________
    DATE ACOMPLISHED

    ATTACHMENT:
    Certified True Copy of Death Certificate
    Certified True Copy of Birth Certificate/ Certified True Copy of Marriage Certificate
    Affidavit of Waiver or Quit Claim (if applicable)

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