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    Revised - Burial Assistance Form - With CN

    Uploaded by

    Arman Bentain
    The document is an application form for burial assistance from the Office of the Vice President of the Philippines. It requests information about the deceased such as name, occupation, and date of death. It also requires details about the authorized representative applying for assistance. Applicants must submit documentation like a social case study report and death certificate. The form provides instructions and warns that fraudulent documents could result in criminal penalties. It lists the documentary requirements and valid IDs accepted.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Revised - Burial Assistance Form - With CN

    Uploaded by

    Arman Bentain
    397 views2 pages
    The document is an application form for burial assistance from the Office of the Vice President of the Philippines. It requests information about the deceased such as name, occupation, and date of death. It also requires details about the authorized representative applying for assistance. Applicants must submit documentation like a social case study report and death certificate. The form provides instructions and warns that fraudulent documents could result in criminal penalties. It lists the documentary requirements and valid IDs accepted.

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    Revised_Burial Assistance Form_with CN

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    The document is an application form for burial assistance from the Office of the Vice President of the Philippines. It requests information about the deceased such as name, occupation, and date of death. It also requires details about the authorized representative applying for assistance. Applicants must submit documentation like a social case study report and death certificate. The form provides instructions and warns that fraudulent documents could result in criminal penalties. It lists the documentary requirements and valid IDs accepted.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    397 views2 pages

    Revised - Burial Assistance Form - With CN

    Uploaded by

    Arman Bentain
    The document is an application form for burial assistance from the Office of the Vice President of the Philippines. It requests information about the deceased such as name, occupation, and date of death. It also requires details about the authorized representative applying for assistance. Applicants must submit documentation like a social case study report and death certificate. The form provides instructions and warns that fraudulent documents could result in criminal penalties. It lists the documentary requirements and valid IDs accepted.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Control Number: FT-PAD-02

    OFFICE OF THE VICE PRESIDENT


    Burial Assistance Application Form
    Processing of Applications and Interviews are done at
    Ground Floor Ben-Lor Bldg., 1184 Quezon Ave., Quezon City
    Contact # (02) 8-370-1714 or 8-370-1716 local 113 and 112
    Email Address: pad@ovp.gov.ph

    Date of Interview
    Record No.

    Name of Deceased FIRST NAME MIDDLE NAME LAST NAME

    Occupation Educational Attainment

    Date of Death MONTH, DAY, YEAR Age Sex Total Cost of Funeral Contract
    Male Female

    Details of Authorized Representative


    The representative must be listed as a family member of the deceased in the DSWD Social Case Study Report

    Name of Authorized FIRST NAME MIDDLE NAME LAST NAME


    Representative

    Relationship to Age Sex Contact Number Signature


    the Deceased Male Female

    Address E-mail Address

    Pursuant to the Data Privacy Act of 2012 (Republic Act 10173), I hereby give my consent to the Office of the Vice President (OVP) to
    process my personal information and sensitive personal information for my application for burial assistance. I understand that the
    processing shall be limited to the purpose specified.

    Ako si _____________________________________, (representative), ay


    nangangako na ang lahat ng impormasyon at dokumentong aking isusumite
    ay tunay at totoo. Naiintindihan ko na ang aking ipinasang aplikasyon ay
    dadaan muna sa pagsusuri upang makumpirma ang katunayan ng mga
    dokumento.
    SIGNATURE OVER PRINTED NAME
    Anumang mapatunayang kasinungalingan o pag gamit ng mga pekeng OF AUTHORIZED REPRESENTATIVE
    dokumento ay magdudulot ng disqualification o pagkansela ng aplikasyon
    para sa Burial Assistance Program at maaaring magresulta sa criminal o DATE
    civil liability gaya ng pagkakulong at multa.

    Evaluation TO BE FILLED OUT BY OVP PERSONNEL

    FOR COMPLETION OF REQUIRED DOCUMENTS Processed by


    Please return on: Actual Date of Return:

    Details/Instructions to be placed on the checklist at the back of this form.

    RECOMMENDED FOR APPROVAL


    SIGNATURE OVER PRINTED NAME
    has submitted complete, valid and updated documentary requirements (per OF PAD STAFF
    checklist at the back page)

    DATE
    DENIED
    Invalid/Non-compliant Documents
    Already Buried/Interred Maximum Assistance that can be
    provided by OVP is ₱5,000 and only
    Others: ____________________________ before burial or interment.

    Version 10.0 June 30, 2022

    PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO AY LIBRE AT WALANG BAYAD.
    Documentary Requirements Checklist BURIAL ASSISTANCE

    Requirements Validity Conditions

    Application Form na nasagutan ng maayos at pirmado ng authorized representative

    Social Case Study Report o Barangay addressed to OVP o generic. Dapat ito ay pirmado ng registered social worker o ng
    Certificate of Indigency Barangay Captain, at ang petsa ay hindi lalampas ng 1 year sa araw ng assessment.

    Registered Death Certificate ito ay dapat may kumpletong detalye at pirma ng authorized staff

    Valid ID ng Deceased (Kung walang Valid ID ay Birth Certificate, hanggat ang detalye ay kaparehas
    ng nakasulat sa Registered Death Certificate at Social Case Study Report
    o Barangay Certificate of Indigency)

    Valid ID ng Authorized Representative (front and back)

    Listahan ng Valid IDs (Dapat hindi expired sa araw ng interview)

    1. Driver’s License 7. PWD ID 13. 4Ps ID Kung ang pasyente ay menor de edad:
    2. NBI Clearance 8. Senior Citizen ID 14. Postal ID 1. Registered Birth Certificate
    3. Passport 9. Solo Parent ID 15. Company ID 2. School ID (kasalukuyang enrolled)
    4. PhilHealth ID 10. TIN ID 16. Barangay ID 3. Barangay ID
    5. Police Clearance/ID 11. UMID/GSIS or SSS ID 17. National ID 4. Service Issue Card
    6. PRC ID 12. Voter’s Certification/ID

    Mga Paalala

    Ayon po sa aming Guidelines, maaari lamang pong makatanggap ng tulong medikal mula sa OVP once every twelve (12) months.
    Ito po ay upang mabigyan ng pagkakataon ang mas marami pang nangangailangang indibidwal na makatanggap ng tulong medikal.

    Para din po sa inyong kaalaman, hindi po namin mapo-proseso ang request na may mga kulang na dokumento.

    Humihingi po kami ng paumanhin kung hindi po agarang mapo-proseso ang inyong aplikasyon. Ito ay dahil sa dami ng bilang ng mga requests
    na natatanggap ng aming opisina. Huwag po kayong mag-alala at kayo po ay agad naming kokontakin tungkol sa status nito kapag ito po ay
    dumaan na sa aming pagsusuri.

    Para sa nais mag follow-up, maaari po kayong tumawag sa 8370-1714 local 113 o mag e-mail sa pad@ovp.gov.ph

    Version 10.0 June 30, 2022

    PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO AY LIBRE AT WALANG BAYAD.

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