SAMPLE GUIDE FOR MONIES WITH MULTIPLE CLAIMANTS

General Instructions:

• SUBMIT ONE (1) LONG FOLDER of ORIGINAL and ONE (1) LONG FOLDER of
PHOTOCOPIED and properly tabbed to each document
• Whenever any discrepancy exists on name, birth date and other information,
submit an Affidavit of 2 Disinterested Persons or Correction of Entry on the civil
registry document (Birth / Marriage / Death Certificate), whichever is applicable
• Incomplete submission shall NOT be entertained
• Photocopied documents must be clear and readable.
• Transact only with authorized employees from AFPTFPD/AFPPGMC. Beware of
FIXERS. (Republic Act 9485 (Anti-Red Tape Law) imposes stiff penalties on
fixers, such as imprisonment of as long as six (6) years, or fine of up to P200,000,
or both.)
• Submission of FAKE DOCUMENTS will be prosecuted for Falsification of Public
Documents and violation of Section 34 of PD 1638.

Note: Kindly secure and complete documentary requirements as applicable.

REQUIREMENTS WHERE TO SECURE

A AFP LEGAL FORMS
1 Affidavit of Undertaking with Special Power of
Attorney
Download at
2 Oath of Office
afppgmc-mil.ph/monies.php
3 Affidavit of Self-Adjudication (Sole
Heir/Claimant only)
B BASIC DOCUMENTS
Download sample format at
1 Waiver of Rights
afppgmc-mil.ph/monies.php
Download at
2 Duly Accomplished Application Form
afppgmc-mil.ph/monies.php
C PSA DOCUMENTS
PSA Death Certificate of Principal Philippine Statistics Authority
1
Pensioner and his/her Spouse, if deceased (PSA) thru:
PSA Marriage Certificate of Principal
2
Pensioner and his/her Spouse 1. PSA Serbilis via
PSA CRS Form #5 (Advisory on Marriages) https://www.psaserbilis.com.ph
of both: with “Delivery To” option to AFP
3 Pension and Gratuity
-Principal Pensioner and
-his/her Spouse Management Center (see next
PSA Birth Certificate/s of Child/ren and/or page) or
4 2. Local Civil Registrar (LCR), if
Grandchild/ren, if by representation
PSA Birth Certificate of Principal Pensioner, if no record in PSA, with Official
5 single upon death Receipt (OR)

D OTHER REQUIREMENTS
Photocopy of valid Government ID (front and
1 back) of all claimants with 3 specimen Claimant/s
signatures
Photocopy of ATM Account (LBP, PVB, or
DBP) with handwritten Account Number and
2 Claims Administrator / Bank
bank snapshot (only for claims administrator
who are not AFP pensioners)
ADDITIONAL REQUIREMENTS FOR DUAL CITIZEN DECEASED PRINCIPAL
E
PENSIONER / ACTIVE BENEFICIARY CLAIMANT/S
Certificate of Naturalization Immigration & Naturalization
1
(Photocopy only) Services of Foreign Country
2 Oath of Allegiance (Photocopy only)
Order of Approval of Citizenship Retention Philippine Embassy/ Consulate /
3
and Re-acquisition (Photocopy only) Department of Foreign Affairs
4 Identification Certificate (Photocopy only)
Select AFP Pension and Gratuity Management Center
 APPLICATION FOR MONIES CLAIMS OR ONE-TIME
PAYMENT FOR AFP PENSION DIFFERENTIAL FY2000 - 13

CLAIMS ADMINISTRATOR

NAME OF DESIGNATED CLAIMS ADMINISTRATOR:

(Print information in capital letters & use BLUE ink only)

(Last Name) (First Name) (Middle Name) (Suffix: Jr, III, IV if any)
DELA CRUZ MARIA TAN

Contact +639552134580 Relationship to the

Date of No:
07 JUL 1957 deceased principal SPOUSE
Birth: (Cellular
Pensioner/Retiree
phone)
OTHER BENEFICIARIES

Relationship to the
Names of other Legal Beneficiaries Date of Birth Contact No. Deceased
Pensioner
MARIA CRISTINA DELA CRUZ CASTRO 08 AUG 1977 +639552134581 DAUGHTER

JUAN DELA CRUZ JR 09 SEP 1994 +639552134582 SON

MARY JANE DELA CRUZ TORRES 10 OCT 2000 +639552134583 DAUGHTER

JUAN DELA CRUZ III 12 DEC 2002 +639552134584 SON

*With Additional Sheet: Yes ❑ No 

I ___MARIA T DELA CRUZ___ DO CERTIFY THAT THE INFORMATION I HAVE PROVIDED ARE
TRUE AND CORRECT, AND I FURTHER CERTIFY THAT:

1. I am the sole or one of the legal beneficiary/ies of the deceased military personnel.
2. I have not filed any previous application for Monies Claims or One-Time payment pertaining to the
AFP Pension Differential covering the period of FY2000 – 2013.
3. I will immediately notify the AFPPGMC or the AFP Task Force for Pension Differential (FY2000-
2013) in case changes of status or other claimants will assert benefits of the deceased AFP Pensioner.

Affix Signature
___________________________________________ _06 NOV 2023__
SIGNATURE OF DESIGNATED ADMINISTRATOR DATE

Witnesses:

Affix Signature
____ BEN T AMBLING___________ 2 x 2 Picture of the Pension
(Signature over printed name) Administrator

______________JUAN C NIPA___________
(Signature over printed name)
OTHER BENEFICIARIES (ADDITIONAL SHEET)

Relationship to the
Names of other Legal Beneficiaries Date of Birth Contact No. Deceased
Pensioner
 AFP Vision 2028: A World-class Armed Forces, Source of National Pride

Republic of the Philippines )

Municipality/City of __________) S.S.

AFFIDAVIT OF UNDERTAKING
WITH SPECIAL POWER OF ATTORNEY

I/We, MARIA T DELA CRUZ, MARIA CRISTINA DELA CRUZ CASTRO, JUAN
DELA CRUZ JR, MARY JANE DELA CRUZ TORRES, JUAN DELA CRUZ III, after
having been sworn to in accordance with law, do hereby depose and say that I/we am/
are:
1. Of legal age, single/married and resident/s of B1L1 FILINVEST SUBD.,
BATASAN HILLS QUEZON CITY, J.P. RIZAL ST., POBLACION, BANGUED, ABRA
respectively;

2. The person/s who would be considered compulsory heirs to the estate of the
late 2LT JUAN DELA CRUZ SR. 123456 PA, who died on 13 JANUARY 2013, being
his/her SPOUSE and CHILDREN (state relationship);

3. Laying claim to the monies due the decedent and undertake to submit all
pertinent, VALID, LEGAL, GENUINE, and AUTHENTIC documents in the processing of
the application for monies claim;

4. Authorizing the Armed Forces of the Philippines (AFP), AFP Pension and
Gratuity Management Center (AFPPGMC), and AFP Task Force for Pension Differential
FY 2000-2013 to release the sum of my/our respective shares to MARIA T DELA CRUZ
(indicate name/s of attorney-in-fact, if applicable) and to acknowledge receipt thereof;

5. Hereby appointing and authorizing for and in my/our behalf MARIA T DELA
CRUZ (name of attorney-in-fact), whose specimen signature appears hereunder, to
undertake any or all of the following:

a) File and process claim, as claims administrator on behalf of all entitled

claimants-heirs, for payment of monies with the AFP, AFPPGMC, and AFP
Task Force for Pension Differential FY 2000-2013;
b) Submit and sign all documentary requirements relative thereto;
c) Receive the sum of the respective shares of all entitled claimants-heirs;
d) To undertake that the sum/amount of monies received shall be held in trust
for MARIA CRISTINA DELA CRUZ CASTRO, JUAN DELA CRUZ JR,
MARY JANE DELA CRUZ TORRES, and JUAN DELA CRUZ III and he/
she not appropriate for himself/herself the monies;
shall
e) Distribute the respective shares of all entitled claimants-heirs to them; and,
f) To perform all and every act requisite or necessary to carry into effect the
foregoing authority as fully to all intents and purposes as we might or could
lawfully do if personally present;

6. I/We shall be held personally liable to any person, natural (unknown legal heir)
or juridical, that may be prejudiced by my/our representations, in addition to other
liabilities, civil or criminal, that may arise therefrom; hereby releasing and discharging the
AFP, AFPPGMC, and AFP Task Force for Pension Differential FY 2000-2013, its officers
and employees, from any and all further obligations in connection with this claim;

AFP Core Values: Honor, Service, Patriotism

 AFP Vision 2028: A World-class Armed Forces, Source of National Pride

7. Undertake to refund the AFP, AFPPGMC, and AFP Task Force for Pension
Differential FY 2000-2013 the amount paid to me/us/attorney-in-fact including interest
thereon and indemnify the AFP, AFPPGMC, and AFP Task Force for Pension Differential
FY 2000-2013, and/or third parties for any loss and/or damages occasioned by such
payment;

8. Further undertake to render free and harmless and defend the Armed Forces of
the Philippines (AFP), AFP Pension and Gratuity Management Center, and AFP Task
Force for Pension Differential FY 2000-2013 against any person or entity from any and all
claims which may hereafter be made on the aforesaid monies;

I/We am/ are executing this affidavit to attest to the truth and veracity of the foregoing
statements.

IN WITNESS WHEREOF, we have hereunto set our hands this ___ day of ____________
at ___________________.

MARIA CRISTINA DC CASTRO MARY JANE DC TORRES

Name & Signature of Affiant Name & Signature of Affiant
ID/ No. 124567894 ID/ No. 526664874
Issuance/Validity Date 01 JAN 2020 Issuance/Validity Date 15 FEB 2012

JUAN DELA CRUZ JR JUAN DELA CRUZ III

Name & Signature of Affiant Name & Signature of Affiant
ID/ No. 003456128 ID/ No. 333859472
Issuance/Validity Date 01 AUG 2018 Issuance/Validity Date 01 FEB 2022

MARIA T. DELA CRUZ

Name & Signature of Attorney-in-Fact
ID/ No. 999524789
Issuance/Validity Date 01 JAN 2010

SUBSCRIBED AND SWORN to before me in the Municipality/City of ______________

this _______ day of _____________________ by the affiants, who have satisfactorily
proven his/her/their identities to me and that he/she/they are the same person/s who
personally signed the foregoing document before me and acknowledged that he/she/they
executed the same.

Notary Public

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________.

AFP Core Values: Honor, Service, Patriotism

 AFP Vision 2028: A World-class Armed Forces, Source of National Pride

GENERAL HEADQUARTERS
ARMED FORCES OF THE PHILIPPINES
OFFICE OF THE JUDGE ADVOCATE GENERAL
Camp General Emilio Aguinaldo, Quezon City

01 January 2023

OATH OF OFFICE

I, __MARIA T DELA CRUZ__, having been appointed by my co-

claimants/heirs as claims administrator, through a Special Power of Attorney,
in the application for monies claim, do solemnly swear that I will faithfully fulfill
/ perform the duties in trust, in accordance with the instruction/s concomitant
with the said designation.

_MARIA T DELA CRUZ

Claims administrator

SUBSCRIBED AND SWORN TO before me this _____ day of _________________,

20___, and the affiant exhibited to me his/her ____________________, issued by
_____________________, expiring on ______________________.

Doc. No. _______;

Page No. ________;
Book No. _______;
Series of 20___.

AFP Core Values: Honor, Service, Patriotism

 WAIVER OF RIGHTS

KNOW ALL MEN BY THESE PRESENTS:

We, the undersigned, of legal age, heirs of the late JUAN T DELA CRUZ SR.,
state that:

1. Our father/mother, JUAN T DELA CRUZ SR., optionally/compulsorily

retired on 01 January 2001;

2. He/She passed away on 12 December 2013 and has an unclaimed

benefit/monies at the time of his/her death;

3. We hereby waive in favor of our mother, MARIA DELA CRUZ, all rights and
interest that we may have over said benefits/monies due the deceased from
AFPPGMC;

4. We hereby release and forever discharge the AFP, AFPPGMC, and AFP Task
Force for Pension Differential FY 2000-2013, its officers and employees from
any and all liability from our co-heirs and/or any other third-party claimant in
connection with the aforementioned waiver and release of the benefits/monies
in favor of the above-named person;

5. We are executing this affidavit to attest to the truth of the foregoing facts and
statements.

IN WITNESS WHEREOF, we have hereunto set our signatures this

______________________ at Quezon City, Philippines.

Affix Signature
MARIA CRISTINA DC CASTRO MARY JANE DC TORRES
Daughter Daughter
ID No. 2356654 ID No. 63442424

Affix Signature
JUAN DELA CRUZ JR JUAN DELA CRUZ III
Son Son
ID No. 32425346 ID No. 53452233

WITNESSES: Affix Signature

______BEN T. AMBLING____ ______JUAN C. NIPA______

Signature over printed name Signature over printed name
REPUBLIC OF THE PHILIPPINES)
CITY OF QUEZON )S.S.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in Quezon City, on the date and at the place
aforementioned, personally came and appeared the parties named above who presented
their competent proof of identities above written. They are known to me to be the same
persons who executed the foregoing instrument and acknowledged to me that the same re
their free act and voluntary deed.

I HEREBY CERTIFY, that this document consists of two (2) pages, including
this page where this acknowledgment is written, has been signed thereof by the concerned
parties and their witnesses.

WITNESS MY HAND AND SEAL, on the day, year, and place first above written.

Doc. No. ________,

Page No. ________,
Book No. ________,
Series of 2023.