Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Sitio San Roque, Brgy. Bagong Pag-asa, Diliman, Quezon City
Telefax Number: 8426-0246 loc 201
PENSIONER’S UPDATE FORM
RETIREE
INSTRUCTION: Fill all applicable spaces legibly. Reproduction of this form is allowed.
Name _____________________________________
Last Name
First Name
________ Retired Rank ____________
Middle Name
Suffix
Present Address ____________________________________________________________ Region _________________
Date Retired ___________________ Amount of Pension _____________ ATM/Bank Account No. _________________
Date of Birth ___________________ Place of Birth __________________ Age _____ Gender _____ Civil Status _______
E-mail Address _______________________________________________ Contact No/s. _________________________
Beneficiaries
Attach 3R (3 ½ x 5 in.) full-body picture holding latest
newspaper of national circulation with the date clearly
shown, and two (2) valid IDs, such as Retiree’s ID,
Driver’s License, Voter’s ID, PRC/IBP ID and Passport.
Date of Birth
Relationship
(Add additional sheet if necessary)
FOR PENSIONER/SURVIVOR OFFICER USE ONLY.
DO NOT WRITE ON THIS PORTION
INSTRUCTION: Check/fill-out appropriate spaces:
If living abroad, provide red ribbon from consul.
1. Health Condition of Retiree
Ambulant ________
2. Living Condition of Retiree
Local ____________
3. With own house?
4. With illegitimate children?
Incapacitated _______
Abroad ____________
Yes _____ No ______
Yes _____ No ______
If Yes, pls. give details:
__________________________________________
__________________________________________
(Add additional sheet if necessary)
Left Thumbmark
Right Thumbmark
I hereby certify that the above information are true
and correct to the best of my knowledge and belief.
_________________________ ______________
Signature over printed name
of Retiree
I hereby certify that I am the pensioner/survivor officer who
checked the veracity of updating and proof of life of this
pensioner/survivor.
______________________________
Name and Signature of
Pensioner/Survivor Officer
________________
Date
Noted by:
Date
BFP-QSF-RBAS-025 Rev.00 (04.19.23)
______________________________
Regional/Provincial Chief, RBS
_________________
Date
Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Sitio San Roque, Brgy. Bagong Pag-asa, Diliman, Quezon City
Telefax Number: 8426-0246 loc 201
BFP-QSF-RBAS-025 Rev.00 (04.19.23)