APIR INTERVIEW FORM

Date Time

✔ OLD AGE PENSION SURVIVORSHIP DEPENDENT MILESTONE

Details:
BALLAD ERLINDA PADUA
Last Name First Name Middle Name

Date of Birth JAN-04-1950 Duration of Video Call

UMID/eCard or ID # 1

(Close-up photo of pensioner here)

ID # 2

GSIS BP Number
UMID/ eCard Number (if available) 006-0093-8714-2
Expiration Date (if with eCard)
Other Identification Cards Presented 1. PhilHealth
2.
Pensioner was assisted by JEFFERSON P. BALLAD
Relationship to pensioner SON

CERTIFICATION
This is to certify that the information given above are true and correct based on the manual
validation/video call I conducted. With this, I am favorably endorsing the commencement of pension.

NAME OF INTERVIEWER HERE

Department/Branch