Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Brgy. Bagong Pag-asa, Diliman, Quezon City

SURVIVOR/DEPENDENT UPDATE FORM

Name(survivor/dependent)___________________________________________________ Relation________________

Rank/Name of deceased BFP personnel ________________________________________________________________

Current Address ____________________________________________________________________________________

__________________________________________________________________________________________________

ATM/Bank Account No. _____________________________ Name of Bank/Branch ______________________________

Contact No/s. _____________________________________ Region ____________ Date of Birth ___________________

Date of Death______________________________ Civil Status ___________ Date Retired _______________

Beneficiaries Date of Birth

_________________________________ ________________

_________________________________ ________________

(Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
_________________________________ ________________
_______________________________ _______________
________________________________ _______________

________________________________ _______________
COMELEC Voter’s ID, PRC/IBP ID and Passport.)

CERTIFIED CORRECT:

CERTIFIED C _________________________ ________________

NHQ/Regional Chief, RBS Date
Left Thumbmark Right Thumbmark
FOR RBAS-PMIS PROCESSOR’S USE ONLY

___________________
Date Processed
I hereby certify that the above information are true
_____________________________
and correct to the best of my knowledge and belief.
Name/Signature of Processor

_________________________ ________________
Signature over printed name Date
MBD Form No. 2011-02
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Brgy. Bagong Pag-asa, Diliman, Quezon City
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
5. Fill-out this Form completely and legibly.
6. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
7. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
8. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
MBD Form No. 2011-02
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.
INSTRUCTIONS:
1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing.