SEARCH
Philippine Government Forms All in One Location
Tweet
Share
Educational Benefits (Application Form)
PVAO guidelines and application form for applying educational benefits
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: EB-AR_______
REV.00, S’2013
Mga Papeles na Kailangan sa Pag-aaply ng Educational Benefit
1.
2.
3.
4.
5.
Military Service Record ng Beterano galing OTAG, AFP
Marriage Contract ng Beterano issued by NSO
Death Certificate ng Beterano issued by NSO
Death Certificate ng asawa ng Beterano kung patay na rin issued by NSO
Waiver of Rights ng mga anak ng Beterano na ibinibigay nila ang kanilang
karapatan sa paggamit ng educational benefit sa apo ng Beterano
6. Birth Certificate ng Anak ng Beterano na magulang ng batang gagamit ng
educational benefit issued by NSO
7. Marriage Certificate ng Anak ng Beterano na magulang ng batang gagamit ng
educational benefit issued by NSO
8. Birth Certificate ng batang gagamit ng educational benefit issued by NSO
9. Sagutin ng kumpleto ang forms na nakalakip sa application ng educational
benefit
10. School credentials ng batang gagamit ng educational benefit gaya ng kanyang
transcript of records, etc.
11. 2x2 picture ng batang gagamit at ng aplikante (Beterano o Asawa ng Beterano o
Anak ng Beterano o Guardian)
P AUNAW A:
Ang mga papeles na nasa bilang 3 at 5 ay Kailangan lang po kung ang
Beterano o Asawa ng Beterano ay patay na.
Ang mga papeles na inyong isusumite ay dapat mga “Original o
Certified true copies”
DIREKSYON PARA SA PAG FILL-UP NG APPLICATION FORM
1. Ang aplikanteng (applicant) tinutukoy sa Application form ay ang Beterano
kung buhay pa siya. Kung patay na, yung naiwang asawa. Kung parehong
patay na, alin man sa mga anak o kaya ang tumatayong guardian ng batang
gagamit ng benepisyo.
2. Ang kalingan lumagda o pumirma at mag-thumbmark sa application form ay
yung aplikante mismo. Halimbawa, ang Beterano kung buhay pa, Asawa ng
Beterano kung patay na ang Beterano, alin man sa isang anak kung
parehong patay and Beterano at Asawa o kaya ang tumatayong guardian ng
batang gagamit ng benepisyo.
3. Ang tinutukoy na “waivee” sa Form 7-4 at Form 7-3 ay ang batang gagamit ng
benepisyo.
PAUNAWA:
Paki kumpleto po lamang ng lahat ng impormasyon na kinakailangan sa
application form at Form 7-3.
EB-AR_______
REV.00, S’2013
APPLICATION REQUIREMENTS FOR EDUCATIONAL BENEFITS
1. Military Service Record of Veteran issued by the Office of the Adjutant General
(OTAG), AFP/ Certification issued by PVAO or Military Service Board (MSB), if
veteran is a “Deserving Guerrilla”
2. Certificate of Marriage of veteran issued by NSO
3. Death Certificate of veteran issued by NSO
4. Death Certificate of surviving spouse of veteran issued by NSO
5. Waiver of Rights of all the children of veteran in favour of the grandchild who will
use the benefit.
6. Birth certificate of veteran’s child issued by NSO
7. Marriage certificate of veteran’s child issued by NSO
8. Birth certificate of the grandchild who will use the benefit issued by NSO
9. 1 copy of Course Curriculum
10. 1 copy of Registration Card or College Admission/ Placement Exam Result (for
incoming college freshman)
11. 2x2 picture of applicant and beneficiary
12. Fingerprint Chart to be accomplished in our Field Service Extension Office (for
students in the provinces)
Note:
Requirements under “item 4 and 5” are only needed if both the veteran
and his spouse are deceased.
Accomplish the enclosed PVAO Form EB_WIS (Waivee Information
Sheet) and the Conforme Letter
Accomplish the attached affidavit (PVAO Form EB_AF) and have it
notarized or administered by a person authorized to administer oath.
Only application forms correctly filled out together with the complete
supporting documents will be accepted for processing.
EB-APP ______
Rev. 00, S’ 2013
Claim No. ___________________
Date Filed: ___________________
Received By: _________________
Republic of the Philippines
Department of National Defense
PHILIPPINE VETERANS AFFAIRS OFFICE
Veterans Compound
Camp General Emilio Aguinaldo, Quezon City
Waivee’s 2x2 Picture
Claimant’s 2x2
Picture
APPLICATION FOR EDUCATIONAL BENEFITS
Series of 2012
001 of 300
1.
2.
3.
INSTRUCTIONS
This application must be accomplished in duplicate, properly signed and thumb marked on the space provided before two (2)
witnesses and the administering officer.
Read and answer carefully all questions, no matter how identical they may appear to be. Type or print answer legibly.
Administering Officer refers to any person authorized by law to administer oath or affirmation.
LAST NAME
1) NAME OF VETERAN
2) SEX OF VETERAN
_____ MALE
_____ FEMALE
FIRST NAME
MIDDLE NAME
_________________________
_______________________
________________________
3) CIVIL STATUS OF VETERAN
_____ MARRIED
_____ WIDOW/WIDOWER
4) DATE OF BIRTH
__________________
PLACE OF BIRTH
__________________
5) IS VETERAN STILL LIVING
_____ YES
_____ NO
IF DECEASED, DATE & PLACE OF DEATH
_____________________________________
DATA OF MILITARY SERVICE OF VETERAN
6) MILITARY SERVICE RENDERED/CATEGORY
___ PHIL REVOLUTION
____ USAFFE
____ USAFFE/GRLA.
____ RECOGNIZED GRLA.
____ MPC
___ NCPG
____ PEFTOK
____ VIETNAM
____ HUKBALAHAP
____ DG/MSB
7) UNIT SERVED/JOINED ___________________________________________________________________________________
8) STATE NAME/S USED IN THE SERVICE ____________________________________________________________________
(IF ALIAS NAME AS WAS USED)
9) ASN ______________
10) DATE OF DISCHARGE, REVERSION OR RETIREMENT ______________________________
MARRIAGE/S CONTRACTED BY THE VETERAN
11) NAME OF SPOUSE
DATE AND PLACE OF MARRIAGE
CAUSE AND DATE TERMINATED
1
2
3
CHILDREN OF VETERAN
12) NAME
DATE AND PLACE OF BIRTH
NAME OF PARENT (VETERAN’S SPOUSE)
1
2
3
4
5
6
7
8
9
10
13)
LAST NAME
FIRST NAME
MIDDLE NAME
NAME OF CLAIMANT:
_________________________
_________________________ _________________________
DATE & PLACE OF BIRTH: _______________________________________________________________________________
RELATIONSHIP TO VETERAN: ___________________________________________________________________________
ADDRESS OF CLAIMANT: ________________________________________________________________________________
INFORMATION ON THE PERSON / BENEFICIARY WHO WILL USE THE BENEFIT
MIDDLE NAME
LAST NAME
FIRST NAME
NAME OF BENEFICIARY: ________________________________________________________________________________
DATE AND PLACE OF BIRTH: ____________________________________________________________________________
RELATIONSHIP TO VETERAN: ___________________________________________________________________________
PARENT OF THE CHILD (CHILD OF VETERAN): ____________________________________________________________
IF BENEFICIARY IS A GRANDCHILD OF VETERAN
NAME OF SCHOOL
DATE ATTENDED
DESCRIPTION OF COURSES /
15) EDUCATION
HONORS RECEIVED
UNIVERSITY / COLLEGE
FROM
14)
ELEMENTARY
SECONDARY
VOCATIONAL
COURSE: _______________________
YEAR/SEM: _____________________
COLLEGE
OTHER CLAIMS FILED WITH PHILIPPINE VETERANS AFFAIRS OFFICE
16) NATURE OF CLAIM
CLAIM NUMBERS
____ OLD AGE PENSION
___________________________
____ BURIAL ASSISTANCE
___________________________
____ DEATH PENSION
___________________________
____ DISABILITY PENSION
___________________________
____ VETERAN PREFERENCE
___________________________
____ BACKPAY RA 304 / 897
___________________________
CERTIFICATION
I, ________________________________________________, HEREBY CERTIFY that I have read all the above
questions carefully, that the answers to all the questions as well as the documents and other material that I have attached
to this application are true and correct; that no educational or similar benefit has ever been filed / enjoyed by the veteran
or any of his dependents / waivees under Philippine Law nor under United States Law; and that I am fully aware of the
penalty provided for under Section 24, Republic Act 6948, for making false statement or committing fraud in connection
with this application.
IN WITNESS WHEREOF, I have hereunto affixed my signature and thumbmarks this day _______ day of
_______________ 20_____.
Thumbmarks
__________________________________
Signature of Applicant
Community Tax Cert. / Iden.t No. ______________
Issued at __________________________________
On _______________________________________
LEFT
RIGHT
WITNESSES:
1) _________________________________________________
2) _________________________________________________
Republic of the Philippines)
______________________) S.S
______________________)
SUBSCRIBED AND SWORN to before me this ________ day of ____________________ 20________. Affiant exhibited
to me Community Tax Certificate # / Identification No. indicated below his / her signature.
____________________________________
ADMINISTERING OFFICER
EB-WIS ______
Rev. 00, S’ 2013
Republic of the Philippines
Department of National Defense
PHILIPPINE VETERANS AFFAIRS OFFICE
Veterans Compound
Camp General Emilio Aguinaldo, Quezon City
Date: _____________________________________________
Veteran: __________________________________________
WAIVEE’S INFORMATION SHEET
Name of Waivee: ____________________________________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
City Address: _______________________________________________________________________________________________
Provincial Address: __________________________________________________________________________________________
Date of Birth: _________________________________________
Place of Birth: ____________________________________
Highest Education Attainment: ___________________________
Year __________________________ Sem/Tri/Qtr/Sum
Course: _______________________________________
School ____________________________________________
Relationship to Veteran: ______________________________________________________________________________________
Upon approval, please state WHERE and WHEN the benefit will be used:
School ________________________________________________
Address __________________________________________
Course ________________________________________________
Period _________________________ Sem/Tri/Qtr/Sum
DID CLAIMANT FILE ANOTHER APPLICATION FOR EDUCATIONAL OR SIMILAR BENEFIT WITH THIS
OFFICE OR WITH THE UNITED STATES LAW OTHER THAN THE ONE BEING APPLIED? __________
IF SO, PLEASE STATE CLAIM NO. ______________________________ DATE FILED ______________________________.
Waivee’s Thumb marks
__________________________________
(Signature of Waivee)
Left
Right
Please use stamping pad ink
to produce clear prints.
CERTIFICATION
I HEREBY CERTIFY THAT ABOVE INFORMATION, SIGNATURE AND THUMBMARKS OF THE ABOVENAMED WAIVEE ARE TRUE AND CORRECT.
Vet/Widow/Gdn/Child of Vet
__________________________________
(Signature of Vet/Widow/Gdn/Child of Vet)
Left
Right
NOTE: This form must be submitted to the Educational Benefits and Hospitalization Management Section upon proper
accomplishment.
EB-AF_______
REV.00, S’2013
REPUBLIC OF THE PHILIPPINES)
___________________________) S.S
___________________________)
AFFIDAVIT
I, ____________________________________________, Filipino, of legal age,
single/married/widow and with postal address at ____________________________
_______________________________________ after having been duly sworn to in
accordance with law hereby depose and say:
That as a veteran/widow/child of deceased veteran/guardian of deceased veteran’s
descendant, no educational or similar benefit has ever been filed in the name veteran or
ant veteran’s direct descendants under Republic Act No. 65, as amended by Republic
Act No. 7696;
That I vouchsafe to the truth that the veteran, his widow, or any of the veteran’s direct
descendant HAS NOT YET ENJOYED Educational Benefit under PHILIPPINE LAW nor
under the UNITED STATES LAW;
That I hereby execute this affidavit, duly aware of the provision of Section 24, of
Republic Act No. 6948, to wit;
Sec. 24 – Fraudulent Claims – “When fraud is shown to have been committed by or with
the knowledge of an applicant for any of the benefits granted under this Act, the
application shall be disapproved or if the application is already approved, such approval
and the award of benefits shall be voided as of the date of its effectivity and all other
benefits under this Act which are due or to become due to the applicant shall be forfeited
without prejudice to the filing of the necessary court action for the fraud committed.
Provided however, that the party or parties to the fraud, upon conviction, shall be
punished by a fine of not more than Two Thousand Pesos (Php2, 000.00) or by
imprisonment for not more than six (6) months, or by both such fine and imprisonment,
at the discretion of the court in addition to the refund of such amount to the Philippine
Veterans Affairs Office has paid in monthly pension or otherwise disbursed in
connection with the fraudulent claim.”
IN WITNESS THEREOF, I hereunto affix my signature this ________ day of
_______________, ________ at _________________________________________
(month)
(year)
__________________________________________________
(AFFIANT)
(Vet/Widow/Grdn/Child of Veteran)
SUBSCRIBED AND SWORN TO before me this _______ day of _______________,
(month)
________at _________________________________________,
(year)
affiant having exhibited to me his/her Community Tax Certificate No. ______________ issued at
______________________________ on ______________.
____________________________
Administering Officer
