Revised EB Processing Form 4, S’2013

Republic of the Philippines

Department of National Defense
PHILIPPINE VETERANS AFFAIRS OFFICE
Veterans Compound
Camp Aguinaldo, Quezon City

Name of Veteran ___________________________________________Claim_no

Name of Widow ___________________________________________Date Filed
Name of Waivee ___________________________________________Date Approved
Organization ______________________________________________Date Waived
Military Status _____________________________________________Waiver Approved

APPLICATION FOR AUTOMATIC EXTENSION UNDER PVAO

(D.O. No A-049, Sec. 24-A, s’90)

COURSE APPROVED ______________________________________City Address

SCHOOL _________________________________________________Prov’l Address

The Administrator
Philippine Veterans Affairs Office
Quezon City

SIR:

I have the honor to request for automatic extension of ________ months which I intent to enjoy
for ______ semester/Trimester/Summer/Quarter, 20____, 20____.

My enjoyments under the Educational Benefits are as follows:

Sem/Sum/Qtr/Tri School Year Course School Student

Very respectfully yours,

(PRINT NAME & SIGNATURES)

SCC Number ________________

FOR CLAIM EXAMINER ONLY

Date _______________________________

ACTION TAKEN:
Period of Entitlement _____________________ Months
Period used to date _______________________ Months
Period available _________________________ Months
With/without extension under D.O. No. A-049, Sec. 24-A, s’90

PROCESSED BY:
______________________ _____________ ____ _______________
NAME POSITION DATE

RECOMMENDATION: APPROVAL/DISAPPROVAL for automatic extension of ______________ months for

______________________________ 20______ - 20______.

_________________________________ _______________
DATE