Republic of the Philippines

Department of the Interior and Local Government

SURVIVOR/DEPENDENT UPDATE FORM

Name(survivor/dependent)___________________________________________________ Relation________________

Rank/Name of deceased BFP personnel ________________________________________________________________

Current Address ____________________________________________________________________________________

__________________________________________________________________________________________________

ATM/Bank Account No. _____________________________ Name of Bank/Branch ______________________________

Contact No/s. _____________________________________ Region ____________ Date of Birth ___________________

Date of Death______________________________ Civil Status ___________ Date Retired _______________

Beneficiaries Date of Birth

_________________________________ ________________

_________________________________ ________________

_________________________________ ________________
(Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the _______________________________ _______________
date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License, ________________________________ _______________

________________________________ _______________
COMELEC Voter’s ID, PRC/IBP ID and Passport.)

CERTIFIED CORRECT:

CERTIFIED C _________________________ ________________

___________________
Date Processed
I hereby certify that the above information are true
_____________________________
and correct to the best of my knowledge and belief.
Name/Signature of Processor

_________________________ ________________
Signature over printed name Date
MBD Form No. 2011-02
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Brgy. Bagong Pag-asa, Diliman, Quezon City

INSTRUCTIONS: INSTRUCTIONS:
1. Fill-out this Form completely and legibly. 1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding 2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License, Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport. COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs 3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture. used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS 4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing. for processing.

INSTRUCTIONS: INSTRUCTIONS:
5. Fill-out this Form completely and legibly. 1. Fill-out this Form completely and legibly.
6. Attach 3R (3 ½ x 5 in.) full-body picture holding 2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License, Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport. COMELEC Voter’s ID, PRC/IBP ID and Passport.
7. Attach one (1) photocopy of the two (2) valid IDs 3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture. used in the picture.
8. Submit this Form to the NHQ/Regional Chief, RBAS 4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing. for processing.

INSTRUCTIONS: INSTRUCTIONS:
1. Fill-out this Form completely and legibly. 1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding 2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License, Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport. COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs 3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture. used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS 4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing. for processing.

INSTRUCTIONS: INSTRUCTIONS:
1. Fill-out this Form completely and legibly. 1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding 2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License, Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport. COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs 3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture. used in the picture.
4. Submit this Form to the NHQ/Regional Chief, RBAS 4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing. for processing.

INSTRUCTIONS: INSTRUCTIONS:
1. Fill-out this Form completely and legibly. 1. Fill-out this Form completely and legibly.
2. Attach 3R (3 ½ x 5 in.) full-body picture holding 2. Attach 3R (3 ½ x 5 in.) full-body picture holding
latest newspaper of national circulation with the latest newspaper of national circulation with the
date clearly shown, and two (2) valid IDs, such as date clearly shown, and two (2) valid IDs, such as
Retiree’s/Pensioner’s ID, SSS, Driver’s License, Retiree’s/Pensioner’s ID, SSS, Driver’s License,
COMELEC Voter’s ID, PRC/IBP ID and Passport. COMELEC Voter’s ID, PRC/IBP ID and Passport.
3. Attach one (1) photocopy of the two (2) valid IDs 3. Attach one (1) photocopy of the two (2) valid IDs
used in the picture. used in the picture.
MBD Form No. 2011-02
4. Submit this Form to the NHQ/Regional Chief, RBAS 4. Submit this Form to the NHQ/Regional Chief, RBAS
for processing. for processing.