Application For Retirement Under Ra 660, Ra 1616, Pd 1146 And Ra 8291 /separation
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4Form No. 040114-RET
APPLICATION FOR RETIREMENT UNDER
RA 660, RA 1616, PD 1146
RA 8291 /SEPARATION
AND
(Please Read Terms and Conditions and Documentary Requirements at the back)
INSTRUCTIONS: Ensure that the application form is properly filled out and submit duly accomplished application form
to the nearest GSIS/Handling Office.
WARNING: Direct or indirect commission of fraud, collusion, falsification, misrepresentation of facts, or any other kind
of anomaly in the accomplishment of this form, or in obtaining any benefit under this application shall be subject to
administrative, civil and/or criminal action.
Date: ______________________________
I hereby apply for a retirement/separation benefit with the GSIS and declare to the best of my knowledge
the following:
Last Name
First Name
Middle Name
GSIS Business Partner (BP) No.
Complete Mailing Address
Date of Birth (mm/dd/yyyy)
Place of Birth
Contact No. (Landline)
Cellphone No.
E-mail address:
Civil Status
Gender:
Married
Single
Separated
Widow/Widower
Female
Male
If married, Name of Spouse: (Last Name, First Name, Middle Name)
Retirement/Separation Benefits Previously
Availed (if applicable):
____________________________________________________________
RA 660
RA 1616
Date of Marriage: _______________________________________________
PD 1146
RA 8291
I choose to avail of retirement benefits under the retirement mode marked below, effective
_________________________________________. I affix my signature beside my chosen option. (Please refer to
Terms and Conditions of each retirement mode on subsequent pages)
RETIREMENT LAW
RETIREMENT OPTIONS
SIGNATURE
Below age 60, monthly annuity payable annually for 5 years
Aged 60 to below 63, 3-year lump sum, 2 years balance payable on the
RA 660
63rd birthday; monthly annuity after the 5-year guaranteed period
Aged 63 and above, 5-year lump sum, monthly annuity after the 5-year
guaranteed period
Immediate Monthly Pension
PD 1146
60 months x Basic Monthly Pension (BMP), and BMP after 5 years
Option 1: 60 months x BMP, and BMP after 5 years
RA 8291
Option 2: 18 months x BMP and BMP to start on date of retirement
Refund of Retirement Premiums (Retirement gratuity to be paid by last
RA 1616
employer)
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