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DBC Application Form PDF

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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James Abetok
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486 views

DBC Application Form PDF

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.

Uploaded by

James Abetok
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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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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