Application For Retirement Under Ra 660, Ra 1616, Pd 1146 And Ra 8291 /separation Page 2
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4If you opt to retire under a retirement scheme with an immediate monthly pension, you may settle your
outstanding loan obligation on installment basis under the Choice of Loan Amortization Schedule for
Pensioners (CLASP) program. The remaining balance of your outstanding obligation shall be restructured
as a loan with an interest rate of 10% per annum compounded annually (paca). Please indicate your
choices below:
APPLICATION FOR
As payment for my outstanding obligations, please deduct from the proceeds of my retirement benefit
CLASP
the amount equivalent to
100%, since I am not availing the CLASP
75%, remaining balance of 25% shall be paid through CLASP
50%, remaining balance of 50% shall be paid through CLASP
25%, remaining balance of 75% shall be paid through CLASP
Preferred repayment term for the remaining balance:
1 year
2 years
3 years.
SEPARATION BENEFIT (RA 8291)
SIGNATURE
1: Below 60 years old with less than 15 years in service (Cash Benefit only)
2: Below 60 years old with more than 15 years in service (Cash Benefit then
pension upon reaching age 60)
3: 60 years old and above with less than 15 years in service – Cash Payment
payable immediately
EFFECTIVITY DATE (Month/Day/Year):
I undertake to submit my Declaration of Pendency/Non-Pendency of Case, duly subscribed and sworn to
DECLARATION OF
before a Notary Public or Administering Officer of my agency-employer, as a condition for the release of
PENDENCY/ NON-
my retirement benefit and in compliance with Section II of CSC Resolution No. 1302242 dated 01
PENDENCY OF CASE
October 2013.
Printed Name and Signature of
Witnesses to Thumb mark:
1. _______________________________
_________________________________________
Thumb mark
2. _______________________________
Signature of Applicant over Printed Name
(if unable to affix signature)
Claim proceeds shall be electronically credited to your eCard/UMID account and may be withdrawn from your nearest
bank or ATM. If you have no eCard/UMID, the proceeds will be paid thru check.
TO BE FILLED OUT BY HEAD OF AGENCY OR HIS AUTHORIZED ENDORSING OFFICER
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Endorsement
Respectfully forwarded to GSIS this application for retirement/separation benefit with our recommendation for approval.
It is hereby certified that the applicant: ( Place a check [√] mark on the pertinent box only)
1.
has rendered/will render his Last Day of Actual Service (LDAS) on _____________________________________________.
2.
has not incurred Leave of Absence Without Pay (LWOP).
3.
has incurred Leave of Absence Without Pay (LWOP) from (mm/dd/yyyy) _____________________________________ to
(mm/dd/yyyy) _________________________________________. (Please attach separate sheet if necessary)
4.
has no pending administrative/criminal case.
5.
has pending administrative/criminal case at ______________________________________________________________
6.
has a decided administrative case with ________________________________. (Please attach certified copy of Decision)
7.
has a decided criminal case with _____________________________________. (Please attach certified copy of Decision)
8.
is applying for Refund of Premiums under RA1616 and the application for gratuity benefit has been approved by this
Office.
Office Name
____________________________________________
_________________________________________________
Signature over Printed Name of the Head of Agency
or his Authorized Endorsing Officer
Office Address
Date: _____________________________________
_________________________________________________
Application Received By:
Date Received
____________________________________
: _______________________________________
TMS Reference No.:
________________________________________________________________________________________________
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