SOP Exhibits
Title
:
Application for Retirement
SOP Number :
HR-PB36
EXHIBIT 6
APPLICATION FOR RETIREMENT
UNDER RA 1616
FOR C.O. OFFICIALS AND EMPLOYEES, F.O. OFFICIALS AND RAOs
_________________________
Date
The Administrator
National Food Authority
Matimyas Building
101 E. Rodriguez Sr. Ave.
Quezon City
Dear Sir,
I have the honor to apply for retirement benefit under Republic Act No. 1616 effective ____________________.
For the information of the Agency, I hereby declare to the best of my knowledge, the following personal data:
Date and place of birth: _____________ Sex: ___ Civil Status ____________
Policy Number: _________ Permanent Address: _______________________
Name of Address of last office: _____________________________________
Previously retired under RA____/PD___ Retirement No. ________on ______
Amount of Retirement pay received _________________________________
Amount Refunded, if any:_________________________________________
Also, I designate the following beneficiaries to receive the retirement benefit in case of my death:
NAME RELATIONSHIP DATE OF BIRTH
___________________ _____________________ ___________________
___________________ _____________________ ___________________
Very truly yours,
_______________________________
(Signature of member/claimant)
_______________________________
(Printed name of member/claimant)
NOTE: If member/claimant cannot sign, thumbmark should be witnessed by two persons. (Print name and sign)
1.___________________________ 2. ______________________________