Form No.

RET-2011-05-02
Date Revised: 2011-05-18

APPLICATION FOR RETIREMENT AND OTHER SOCIAL INSURANCE BENEFITS

(Please read instructions at the back)
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 and/or criminal action.

________________________
Date
THE PRESIDENT & GENERAL MANAGER Latest 1x1 Picture
Government Service Insurance System (within the last 3
Financial Center, Roxas Blvd., Pasay City 1308 months)

Sir:

For the information of the System, I hereby declare to the best of my knowledge the following:
*Last Name *First Name *Middle Name *GSIS ID No.

*Date of Birth: Place of Birth: Civil Status:

[ ] Married [ ] Single [ ] Separated [ ] Widow
*Residence/Mailing Address: Contact No. *Cellphone No.

I have the honor to apply for:

[ ] Retirement benefits under the retirement mode marked below, effective _____________________________

Please indicate if you will avail of the Portability Law: ( ) NO ( ) YES, (if yes, please accomplish also the Application Form for Portability Law

( ) Below age 60, monthly annuity

( ) Aged 60 to below 63, 3 year lump sum, 2 years balance payable on the 63rd birthday; monthly annuity after the 5 year
Under RA 660
guaranteed period
( ) Aged 63 and above, 5-year lump sum, monthly annuity after the 5-year guaranteed period
( ) Monthly annuity
Under PD 1146 Old-Age Benefits:
( ) Lump sum of 60 x Basic Monthly Pension (BMP), and BMP after 5 years

OPTION 1: ( ) Lump sum of 60 x BMP, and BMP after 5 years

Under RA 8291 Retirement Benefits:
OPTION 2: ( ) Cash benefit of 18 x BMP and BMP to start on date of retirement

Under RA 1616 ( ) Refund of Retirement Premiums

If you opted to retire under a retirement scheme with an immediate pension, you are qualified to avail of the Choice of Loan Amortization Schedule for
Pensioners (CLASP). 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:

Please deduct from the proceeds of my retirement benefit the amount equivalent to: _________________________________ (please choose among
the following: a) 100%; b) 75%; c) 50%; or d) 25%), as payment for my outstanding obligations with the GSIS, with a repayment term of:
_________________ (please choose among the following: a) 1 year; b) 2 years; or c) 3 years).

[ ] Separation Benefits Effectivity Date: __________________ [ ] Unemployment Benefits Effectivity Date: __________________
(See back portion of this form for Eligibility Requirements and Conditions for Retirement, Separation/Unemployment Benefits)

[ ] Cash Surrender/Termination Value in view of, my: [ ] Maturity Value

[ ] resignation [ ] retirement
[ ] separation from the government service on ____________________.
State other reason/s : _________________________________________

It is understood that the entire outstanding balance of my policy loan as well as the arrearages and balances of my other loans and
accountabilities with the GSIS which are due and demandable shall be deducted from the said benefit pursuant to RA 8291 and the existing
policies of the GSIS.

*Mandatory Field
For those applying for Retirement benefits only:
[ ] I have not availed of benefits under other law/s similar to the claim covered by this application for __________________ (retirement, separation, etc.)
benefits under RA 8291; or
[ ] I have availed of ___________________ benefits under ___________________, which are similar to the benefits covered by this application for
________________ (retirement, separation, etc.) benefits under RA 8291, in the amount of P______________________.
Very truly yours,

___________________________________________ Right Thumbmark

Signature of Applicant over Printed Name

TO BE FILLED UP BY THE PERSONNEL OFFICER OF THE AGENCY

The undersigned hereby certifies that M_________________________________________________________________, an employee of this office and who
has not reached the compulsory age of retirement, [ ] who is in active status has filed for maturity benefits [ ] resigned from this agency [ ] applied
for Separation Benefit and has been separated from the service [ ] retired from the service [ ] has applied for unemployment benefit and has
been involuntarily separated from the service as a result of: [ ] abolition/reorganization of his office; [ ] abolition of his position in this agency, effective
_______________________________, and this office was duly informed of such.

_____________________________________________ _________________________________________________ __________________

Signature of Personnel Officer over Printed Name Name of Agency/Last Office Before Retirement Date

__________________________________________________________________________________
Address of Agency
INSTRUCTIONS:

1. Ensure that the application form is properly filled up.

2. Agency to submit two (2) copies of the accomplished application form to the nearest GSIS/Handling Office.

TERMS AND CONDITIONS

I. RETIREMENT

A. ELIGIBILITY REQUIREMENTS

1. Member shall be entitled to the retirement benefit on condition that:

1. He/She has been in the service on or before May 31, 1977; and,
2. He/She has met the age and service requirements as indicated below:
Under RA 660 Age 52 53 54 55 56 57 58 59 60 61 62 63 64 65
YCS 35 34 33 32 31 30 28 26 24 22 20 18 16 15
1. He/She has been in the service as of May 31, 1977;
2. He/She has rendered at least fifteen (15) years of service in the government;
Under PD 1146
3. He/She is at least sixty (60) years of age at the time of retirement; and,
4. He/She is separated from the service.
1. He/She has been in the service as of June 24, 1997;
2. He/She has rendered at least fifteen (15) years of service in the government;
Under RA 8291 3. He/She is at least sixty (60) years of age at the time of retirement; and,
4. He/She is not receiving a monthly pension benefit due to permanent total disability.
5. Uniformed Personnel of PNP, BJMP and BFP are excluded.
1. He/She has been in the service on or before May 31, 1977;
Under RA 1616 2. He/She must have at least sixty (60) years of age at the time of retirement; and,
3. He/She must have at least twenty (20) years of creditable service in the government.

2. Request for conversion from one mode of retirement to another shall not be allowed.
3. The retirement proceeds shall at all time be subject to deduction for any outstanding indebtedness the member may have incurred with the GSIS
(Section 39, RA 8291 otherwise known as the GSIS Retirement Law).

B. CONDITIONS FOR RECEIPT OF MONTHLY PENSION

After the 5-year guaranteed period - RA 660 / RA 8291; Future payment (Upon reaching age 60) – PD 1146 / RA 8291

The retiree is required to personally appear at GSIS Office nearest his/her place of residence. He/She shall be required to fill up a request for
commencement of pension form and afterwards enroll for the GSIS UMID-Compliant eCARD/Kiosk transaction card. If the retiree is already enrolled
and in possession of a GSIS UMID-Compliant eCard, he/she shall be required to enroll in the GVAPS and his/ her present role/status shall be
tagged/changed accordingly.

II. SEPARATION

A. ENTITLEMENT TO SEPARATION BENEFITS (As provided for in Section XI of RA 8291)

A member who has accumulated a minimum of three (3) years creditable service shall be entitled to separation benefit upon resignation or separation under
the following terms:

1. For member with at least three (3) years but less than fifteen (15):

A cash payment equivalent to one hundred percent (100%) of the average monthly compensation for every year of creditable service the member has
paid contributions, but not less than Twelve Thousand Pesos (P12,000), payable upon reaching sixty (60) years of age or upon separation, whichever
comes later.

2. For member with at least fifteen (15) years of service and less than sixty (60) years of age upon separation:
a. A cash payment equivalent to eighteen (18) times the basic monthly pension, payable at the time of resignation or separation;
b. An old-age pension benefit equal to the basic monthly pension, payable monthly for life upon reaching age 60.

B. PRESCRIPTIVE PERIOD FOR FILING OF SEPARATION BENEFIT

Application for separation benefits must be filed within 4 years from the date of separation as provided for under Sec. 28 of RA 8291.
III. UNEMPLOYMENT BENEFIT
A. CONDITIONS FOR ENTITLEMENT
1. A member shall be entitled to the unemployment benefit in the form of monthly cash payments if all the conditions below are satisfied:
1.1 He/She was a permanent employee at the time of separation;
1.2 His/Her separation was involuntary due to the abolition of his/her office or position resulting from reorganization; and,
1.3 He/She has been paying the contributions specified under Rule 3.1 (a) for at least one (1) year prior to separation.

2. A member who has rendered at least 15 years of service will be entitled to the separation benefits described in Rule VI, instead of unemployment
benefit.

3. Application for unemployment benefit must be filed within 4 years from the date of unemployment as provided for under Sec. 28, RA 8291.

B. AMOUNT, DURATION AND PAYMENT OF BENEFIT

1. Unemployment benefits in the form of monthly cash payments equivalent to fifty percent (50%) of the average monthly compensation shall be paid to
permanent employee who is involuntarily separated from the service due to the abolition of his office or position usually resulting from reorganization:
Provided, that he/she has been paying integrated contributions for at least one (1) year prior to separation. Unemployment benefit shall be paid in
accordance with the following schedule:

Contribution Made Benefit Duration

1 year but less than 3 years 2 months
3 or more years but less than 6 years 3 months
6 or more years but less than 9 years 4 months
9 or more years but less than 11 years 5 months
11 or more years but less than 15 years 6 months

2. Those entitled to more than two (2) months of Unemployment Benefits shall initially receive two (2) monthly payments. A seven-day waiting period
shall be imposed on succeeding monthly payments to determine whether the separated member has found gainful employment either in the public or
private sector. In this regard, the member is required to immediately notify the GSIS at anytime he/she finds gainful employment or reenters the
salaried workforce within the period of the benefit. If the member fails to report to GSIS his/her reemployment and continues to illegally receive the
benefit, administrative and/or criminal action shall be instituted by the GSIS against the member.

3. All accumulated unemployment benefits paid to the employee during his/her entire membership with the GSIS shall be deducted from the separation
benefits to which the member may be entitled to upon his voluntary resignation or separation.