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Withdrawal Form

This document outlines the general requirements and process for submitting a withdrawal claim to the Philippine Public School Teacher Association retirement benefits program. It lists the necessary documents which include a certificate of membership, withdrawal letter, valid ID copies, and recent payslips. It also requests information on how and where to send the withdrawal check proceeds and includes spaces for the applicant's signature and contact details.

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Jerico D. Campos
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294 views

Withdrawal Form

This document outlines the general requirements and process for submitting a withdrawal claim to the Philippine Public School Teacher Association retirement benefits program. It lists the necessary documents which include a certificate of membership, withdrawal letter, valid ID copies, and recent payslips. It also requests information on how and where to send the withdrawal check proceeds and includes spaces for the applicant's signature and contact details.

Uploaded by

Jerico D. Campos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PHILIPPINE PUBLIC SCHOOL TEACHER ASSOCIATION

245 Banawe St., Quezon City


Retirement Claims Department
Website: www.ppsta.net; Email: [email protected]
Tel Nos.: (02) 988-14-19 / (02) 988-14-20 local: 303 to 307
Mobile Nos: 0906-2538260/0917-5714986

Sir / Madam:

I have the honor to submit herewith a claim application for benefit under the New Mutual Retirement
Benefit System (NMRBS), Mutual Retirement Benefit System (MRBS), and Mutual Retirement Benefit System
Plus (MRBS Plus). The following information is hereby furnished for the Withdrawal Benefit of the
___________________________________

A. General Requirements - Withdrawal claim:

Certificate of Membership:

NMRBS Policy MRBS Policy MRBS Plus Policy

In case of loss, Affidavit of Loss (re: PPSTA Certificate)

Withdrawal Letter with Signature

Clear photocopy of two Valid ID’s with signature and contact number (back and front)

Latest Payslip
For Active Members
Latest Pay slip showing last deduction and succeeding pay slip with no
deduction (for NMRBS and MRBS Plus only)

Remarks:

Mail my check to: Sub-office Home Address OR coming on schedule date _________

Upon receipt of the proceeds of the said benefit, I shall release and forever discharge the
Association, its assigns and successors-in-interest from any similar claims whatsoever arising from my
membership with the Association.

2 Specimen Signatures
___________________ ________________________________
Signed Over Printed Name
___________________ (Member)

______________________________
Address:

_______________________________
Contact Number:

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