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08.11 BA App Form Version 16.0

This document contains information and forms related to applying for burial assistance from the Office of the Vice President of the Philippines. Key details include: - Applications must be submitted within 15 days of the date of death and provide an assistance of P5,000. - The application form requires information about the deceased and authorized representative, including names, dates, relationships, and contact details. - Applicants consent to having their information collected and used for evaluating and processing the request, as well as for broader community assistance purposes. - Documentary requirements include an original application form, case study report, death certificate, valid ID of the deceased and representative, and may require additional documents for verification.

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deparo2023
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29 views

08.11 BA App Form Version 16.0

This document contains information and forms related to applying for burial assistance from the Office of the Vice President of the Philippines. Key details include: - Applications must be submitted within 15 days of the date of death and provide an assistance of P5,000. - The application form requires information about the deceased and authorized representative, including names, dates, relationships, and contact details. - Applicants consent to having their information collected and used for evaluating and processing the request, as well as for broader community assistance purposes. - Documentary requirements include an original application form, case study report, death certificate, valid ID of the deceased and representative, and may require additional documents for verification.

Uploaded by

deparo2023
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Version 16.

0 – 11 Aug 2023
Control Number: FT-PAD-01
Republic of the Philippines
Office of the Vice President

BURIAL ASSISTANCE APPLICATION FORM


(PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO AY LIBRE AT WALANG BAYAD)

Important Note: We can only accept Burial applications within 15 calendar days (including weekends and holidays) from the date
of death, for an assistance worth of P5,000.00.

Date of Interview Record Number

Application - To be filled out by the client:

FIRST NAME MIDDLE NAME LAST NAME


Name of Deceased

MONTH, DAY, YEAR Age Sex Person with Disability (PWD)


Date of Death Male Female Yes No

Details of Authorized Representative


The representative must be listed as an immediate family member of the deceased in the Social Case Study Report
FIRST NAME MIDDLE NAME LAST NAME
Name of Authorized
Representative

Address

Age Sex Signature


Relationship to
the Deceased Male Female

E-mail Address
Contact Number

Please be informed that sensitive, confidential, and personal data/information, collected by the Office of the Vice President (OVP) in relation to your request
for burial assistance shall be used solely for the processing of your request and may be forwarded to Partner Agencies, where the processing is necessary for
compliance with a legal obligation to which the OVP is bound, subject to the provisions of the Data Privacy Act of 2012.

For data privacy related concerns, you may contact the OVP Data Privacy Officer at 11/F Cybergate Plaza, EDSA cor. Pioneer Street, Mandaluyong
City through Tel. No.: 83701711 loc. 1130 or email: dpo@ovp.gov.ph.
Evaluation - To be filled out by the OVP Personnel:

RECOMMENDED FOR APPROVAL Recommending Approval:


Has submitted complete, valid, and updated documentary requirements (per checklist at the back
page)

FOR COMPLETION OF REQUIRED DOCUMENTS Remarks:


Please return on: Actual Date of Return:

DENIED
Invalid/Non-compliant Documents
Beyond 15 days from the Date of Death
Others: _____________________

Eligible beneficiaries may submit their applications through the OVP Central Office or Satellite Offices (SO) on Mondays to Fridays, 8:00 AM to 5:00
PM. Early cut-off time may be implemented to ensure that clients will be served within the day.

11F, Robinsons Cybergate Plaza, EDSA cor. Pioneer St., Mandaluyong, 1550, Metro Manila
Tel. No. 8532-5942/ 8370-1719 vp@ovp.gov.ph
Version 16.0 – 11 Aug 2023
Republic of the Philippines
Office of the Vice President

CLIENT WAIVER & CONSENT FORM


(PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO AY LIBRE AT WALANG BAYAD)

Pangalan (Representative): __________________________________________________________


Contact Number:__________________________________________________ Date:__________________

Ako ay sumasangayon sa mga sumusunod:


1. Lahat ng impormasyon at dokumentong aking isusumite ay tunay at totoo. Naiintindihan ko na ang
aking ipinasang aplikasyon ay dadaan muna sa pagsusuri upang makumpirma ang katunayan ng mga
dokumento.
2. Anumang mapatunayang kasinungalingan o pag gamit ng mga pekeng dokumento ay magdudulot
ng disqualification o pagkansela ng aplikasyon para sa Medical Assistance Program at maaaring
magresulta sa criminal o civil liability gaya ng pagkakulong at multa.
3. Ang Office of the Vice President (“OVP”) ay maaaring kumuha at gumamit ng aking impormasyon
upang: (a) alamin ang mga pangunahing pangangailangan ng aking komunidad o sektor; (b) bumuo
ng mga plano para tugunan ang mga pangangailangan; (c) i-monitor ang pagpapatakbo o resulta ng
mga plano; (d) ilahad sa ibang tao ang aking karanasan kabilang ang pinagdaanang kahirapan at
anumang tagumpay na nakamtan.
4. Pinapahintulutan ko ang OVP sa pangongolekta, paggamit at pagproseso ng aking personal na
impormasyon alinsunod sa mga layunin na nakasaad dito. Pinapahintulutan ko ang OVP na ibahagi
ang mga impormasyon sa ibang mga partido, lokal man o internasyonal, ayon sa pangangailangan
at nararapat para sa katuparan ng mga layunin at ang paggamit at paglalantad ay makatwiran,
kailangan , pinapahintulutan at naayon sa batas, alinsunod sa Data Privacy Act of 2012 at
Implementing Rules nito.
5. Pinahihintulutan ko ang OVP (o ang Partner) na kunin, irekord, at gamitin sa anumang paraan ang
aking panayam, kabilang ang aking personal na impormasyon, imahe, at tinig, sa kabuuan o bahagi
man, sa mga larawan, bidyo, lathala, audio at iba pang media, sa loob o sa labas ng Pilipinas, para
sa mga layuning nakasaad sa itaas at sa iba pang naaayon sa batas.
6. Wala akong copyright sa alinmang materyal na makakalap, at maaari itong gamitin o i-edit batay sa
sariling pagpapasya ng OVP (o ng Partner) nang hindi nangangailangan ng aking pahintulot at walang
anumang kabayaran kapalit nito.
7. Tunay at kumpletong impormasyon lamang ang ibibigay ko sa OVP.
8. Wala akong kahit anumang pananagutang hihingin mula sa OVP (o sa Partner) sa dahilan ng paggamit
ng impormasyong makakalap.
9. May karapatan at kakayahan akong maisagawa ang pagsang-ayong ito. Wala dito ang sumasalungat
o lumalabag sa anumang pag-unawa o kasunduan na mayroon ako sa sinuman, o anumang
karapatang nauukol sa iba.
10. Ang pagsang-ayong ito ay pamamahalaan ng batas ng Republika ng Pilipinas.
11. Nabasa ko ang mga tuntunin ng pagsang-ayong ito at kusang-loob ko itong isinasagawa nang walang
tinatanggap na anumang konsiderasyon.

SIGNATURE OVER PRINTED NAME

11F, Robinsons Cybergate Plaza, EDSA cor. Pioneer St., Mandaluyong, 1550, Metro Manila
Tel. No. 8532-5942/ 8370-1719 vp@ovp.gov.ph
Version 16.0 – 11 Aug 2023
Republic of the Philippines
Office of the Vice President

DOCUMENTARY REQUIREMENTS
(PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO AY LIBRE AT WALANG BAYAD)

General Requirements List of Valid IDs Alternative Docs for Deceased


1. Original Copy of the Burial Application • Driver’s License ● Registered Birth Certificate
Form. Applications must be submitted within ● Solo Parent ID ● Fetal Death Certificate
15 days from the date of death. ● NBI Clearance / ID
2. Original Copy of the Social Case Study ● TIN ID Alternative documents in
Report/Certificate of Indigency or ● Passport case of lack of valid ID due
Eligibility issued by the DSWD, PSWDO, ● UMID/GSIS/SSS ID to fire, insurgency, or
CSWDO, MSWDO, or Medical Social Worker in ● PhilHealth ID calamity in the area:
the hospital, and addressed to the OVP, or ● Voter’s Certification
generic addressee (e.g., addressed to “your ● Police Clearance / ID 1. Justification from the PAD
good office”, no addressee) ● 4Ps ID Chief/SO Lead; and
3. Photocopy of Registered Death Certificate ● PRC ID 2. Barangay Certification stating
with registry number. ● Postal ID that: a) the person is a resident
4. Photocopy of one (1) valid Identification ● PWD ID in the barangay; and b) there
Card (ID) of: ● Senior Citizen ID was a fire/insurgency/calamity
a. Deceased ● Barangay/ LGU ID which resulted to the
b. Authorized representative ● Philippine Identification loss/unavailability of valid ID.
System (National ID)

The original documents shall be presented during the interview for validation. Processors/Verifiers may request for additional supporting
documents should the application require further validation and justification. Such additional documents may include, but are not limited to,
an Affidavit of Name Discrepancy for Correction of Entry, Police Report for Vehicular Accidents, Marriage Contract, and etc.

11F, Robinsons Cybergate Plaza, EDSA cor. Pioneer St., Mandaluyong, 1550, Metro Manila
Tel. No. 8532-5942/ 8370-1719 vp@ovp.gov.ph

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