REPUBLIC OF THE PHILIPPINES

Department of National Defense

PHILIPPINE VETERANS AFFAIRS OFFICE PASSPORT
Camp General Emilio Aguinaldo, Quezon City
SIZE
PICTURE
APPLICATION FOR OLD AGE PENSION
(VETERAN)
(AFP RETIREE)

(IMPORTANT: PLEASE FILL-UP THIS FORM COMPLETELY AND SUBMIT THE SAME TOGETHER WITH THE REQUIRED DOCUMENTS
LISTED HEREIN. INCOMPLETE DATA ON APPLICATION FORM & INSUFFICIENT DOCUMENTS WILL NOT BE ACCEPTED).

FAMILY NAME FIRST NAME MIDDLE NAME (LEAVE THIS SPACE BLANK)

CLAIM NO. :
ADDRESS: Street
Town/City ENCODED BY :
Province
DATE :
Zip Code:

DATE OF BIRTH: PLACE OF BIRTH:

NAME OF LEGAL SPOUSE: DATE & PLACE OF MARRIAGE:

RANK: SERIAL NO. MAJOR SERVICE: NATIONALITY:

DATE OF RETIREMENT / DISCHARGE: LAST UNIT OF ASSIGNMENT:

DOCUMENTARY REQUIREMENTS:

 Retirement Order / Military Service Record from AFP

 Photocopy of AFP Pensioner’s ID (Original Presented)

DECLARATION OF APPLICANT

I declare that the information i have given in this application is truthful, complete and correct.
I understand that any false statements or concealment of information may result in the disapproval of my application.
I have not been discharged or separated from the military service under dishonorable conditions.
I am fully aware of the consequences of committing fraud in connection with this application.

In witness whereof, I have hereunto affixed my signature and thumbmarks this ____________________ day of
_____________________________ 20____.

THUMBMARKS OF VETERAN
LEFT RIGHT
______________________________________
(Applicant’s Signature over printed name)

(This portion is to be filled up by the PVAO examiner)

Review and evaluated by: ___________________________________________________________

Date : ___________________________________________________________

** This application form is made available FREE OF CHARGE by the Philippine Veterans Affairs Office. **
** This application form can also be downloaded thru PVAO website at www.pvao.mil.ph **