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YVOP Form FINAL

This document contains a yearly verification of pensioner's form used by the Philippine Coast Guard Pension and Gratuity Management Center. The form collects essential information about pensioners such as name, date of birth, retirement details, contact information, employment status, and dependent details. It requires certification from the barangay chairman and submission of identification documents to verify pensioner information and proof of life on an annual basis. Instructions are provided on the required documents for different pensioner types such as retirees, survivors, or those living abroad to complete the yearly verification process.

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Joshua O. Apuya
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
559 views

YVOP Form FINAL

This document contains a yearly verification of pensioner's form used by the Philippine Coast Guard Pension and Gratuity Management Center. The form collects essential information about pensioners such as name, date of birth, retirement details, contact information, employment status, and dependent details. It requires certification from the barangay chairman and submission of identification documents to verify pensioner information and proof of life on an annual basis. Instructions are provided on the required documents for different pensioner types such as retirees, survivors, or those living abroad to complete the yearly verification process.

Uploaded by

Joshua O. Apuya
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PHILIPPINE COAST GUARD

PENSION AND GRATUITY MANAGEMENT CENTER


YEARLY VERIFICATION OF PENSIONER’S FORM
C.Y. ________ PENSIONER’S REPLY
THIS FORM IS NOT FOR SALE
PLEASE READ INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL
INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY.
PART I – MEMBER’S / PENSIONER’S INFORMATION
TYPE OF RETIREMENT
Compulsory Optional Posthumous Complete Disability Discharge Beneficiary

Serial No. of Pensioner Rank of Pensioner Date of Birth Date of Retirement


(MMDDYYYY) (MMDDYYYY)

NAME (SURNAME) (GIVEN NAME) (MIDDLE NAME) (SUFFIX)

LOCAL ADDRESS (RM/ FLR/ UNIT NO. & BLDG NAME) (HOUSE/ LOT & BLOCK NO.) (STREET NAME)

(BRGY/ DISTRICT/ LOCALITY) (SUBDIVISION) (CITY/ MUNICIPALITY) (PROVINCE) ZIP CODE

TELEPHONE NO. (Area Code + MOBILE/ CELLPHONE NO. E-MAIL ADDRESS


Tel No)

FOREIGN ADDRESS (If applicable)

COAST GUARD DISTRICT (COVERED) COUNTRY ZIP CODE

PART II – LEGAL BENEFICIARY’S INFORMATION


NAME OF LEGAL BENEFICIARY
(SURNAME) (GIVEN NAME) (MIDDLE NAME) (SUFFIX) AGE CITIZENSHIP

LOCAL ADDRESS RELATIONSHIP TO THE PENSIONER

IF RECEIVING PENSION AS GUARDIAN, INDICATE NAME


(SURNAME) (GIVEN NAME) (MIDDLE NAME) (SUFFIX)

PART III – QUESTIONNAIRE


1. FOR TOTAL DISABILITY / RETIREMENT PENSIONER, HAVE YOU BEEN RE – EMPLOYED / RESUMED
SELF – EMPLOYMENT? YES NO
IF YES, NAME AND ADDRESS OF PRESENT EMPLOYER: ____________________________________________

DATE RE-EMPLOYED OR RESUMED SELF – EMPLOYMENT: _________________________________________

2. FOR DEATH PENSIONER, HAVE YOU RE – MARRIED OR CURRENTLY COHABITING WITH ANOTHER
PERSON? YES NO
IF YES, NAME OF SPOUSE/ PARTNER: _________________ DATE OF MARRIAGE/ COHABITATION: _________

1 | 3NOTICE:Anyone who falsifies essential information requested by this or a related from may, upon conviction, be subject to fine and
imprisonment under the law.
3. ARE YOU UNDER THE CARE AND CUSTODY OF A GUARDIAN?
YES NO
IF YES, NAME AND ADDRESS OF GUARDIAN: ____________________________________________________

4. IS THERE ANY DEPENDENT CHILD WHO ARE BELOW 21 YEARS OF AGE AND STILL SINGLE?
YES NO
IF YES, FILL OUT THE DATA BELOW:

NAME OF DEPENDENT NAME OF OCCUPATIO DATE OF


DATE OF BIRTH
(Children below 21 y/o) GUARDIAN N DEATH
1)
2)
3)
4)
5)
6)
7)
8)
I HEREBY CERTIFY that the foregoing information is complete, true and correct to the best of my knowledge.

__________________________ __________
Signature over printed name Date

(If unable to sign, affix fingerprints with the signature of two (2)
witnesses and submit photocopy of one (1) valid ID with photo LEFT THUMB RIGHT THUMB
and signature of each witness)

WITNESSES TO FINGERPRINTS:

1) _____________________________ ________ 2) ____________________________ _________


Signature over printed name Date Signature over printed name Date

PART IV – CERTIFICATION OF BARANGAY CHAIRMAN


(FOR RETIREE AND SURVIVOR PENSIONERS)

THIS IS TO CERTIFY that Mr./ Ms. ______________________, a depositor/ bonafide resident of

____________________________________________personally appeared before the undersigned on

______________________ as compliance to the annual confirmation of pensioners being conducted by the

Office of the Philippine Coast Guard-Pension and Gratuity Management Center.

___________________________ _________
Signature over printed name Date

2 | 3NOTICE:Anyone who falsifies essential information requested by this or a related from may, upon conviction, be subject to fine and
imprisonment under the law.
FOR LOCAL RESIDENT PENSIONERS : FOR PENSIONERS LIVING ABROAD :

 Accomplished YVOP Form  Accomplished YVOP Form


 Photocopy of Pensioner’s ID & one (1)  Photocopy of Pensioner’s ID & one (1)
Valid ID with three (3) signatures valid ID with three (3) signatures
 Proof of Life  Photocopy of Valid ID issued by host
- Whole body picture holding any country Governmental unit/agency
current newspaper (date must be  Proof of Life
clearly indicated) - Whole body picture holding any
current newspaper (date must be
clearly indicated)

FOR QUALIFIED BENEFICIARY OF DECEASED FOR COMPLETE DISABILITY DISCHARGE (CDD)


PENSIONERS : PENSIONERS :

 Accomplished YVOP Form  Accomplished YVOP Form


 Photocopy of Pensioner’s ID & one  Photocopy of Pensioner’s ID & one (1)
(1) Valid ID with three (3) signatures Valid ID with three (3) signatures
 Declaration of Legal Beneficiary  Sketch of Residence
 Photocopy of PSA Birth Certificate
 Proof of Life
(if child)
- Whole body picture holding any
 Photocopy of PSA Advisory on
Marriage (if spouse) current newspaper (date must be
 Photocopy of PSA CENOMAR clearly indicated)
(Certificate of No Marriage)
 Proof of Life
- Whole body picture holding any
current newspaper (date must be
clearly indicated)

FOR QUALIFIED BENEFICIARY WHO ARE FOR INQUIRIES,


MENTALLY & PHYSICALLY INCAPACITATED : YOU MAY CONTACT US AT :

 Accomplished YVOP Form


 Photocopy of Pensioner’s ID & one (1)
Valid ID with three (3) signatures
 Declaration of Legal Beneficiary PENSION AND GRATUITY MANAGEMENT CENTER
 Medical Certificate (Government or ADDRESS: 139 25th Street, Port Area, Manila
Private Hospital) Facebook: www.facebook.com/PCGPGMC
 Proof of Life E-Mail: [email protected]
- Whole body picture holding any Mobile Nr: 09260646613 - GLOBE
current newspaper (date must be clearly 09287264445 - SMART
indicated)

3 | 3NOTICE:Anyone who falsifies essential information requested by this or a related from may, upon conviction, be subject to fine and
imprisonment under the law.

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