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    MR Form Oct 2020

    Uploaded by

    rpreyes14
    The document provides instructions for filling out a Member's Record form for the Private Education Retirement Annuity Association Fund. It explains that the form collects identifying and employment information as well as beneficiary details. It is used to establish a member's permanent record and for processing claims. Beneficiaries can be designated as primary or contingent.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    MR Form Oct 2020

    Uploaded by

    rpreyes14
    5 views2 pages
    The document provides instructions for filling out a Member's Record form for the Private Education Retirement Annuity Association Fund. It explains that the form collects identifying and employment information as well as beneficiary details. It is used to establish a member's permanent record and for processing claims. Beneficiaries can be designated as primary or contingent.

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    © © All Rights Reserved

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    The document provides instructions for filling out a Member's Record form for the Private Education Retirement Annuity Association Fund. It explains that the form collects identifying and employment information as well as beneficiary details. It is used to establish a member's permanent record and for processing claims. Beneficiaries can be designated as primary or contingent.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    5 views2 pages

    MR Form Oct 2020

    Uploaded by

    rpreyes14
    The document provides instructions for filling out a Member's Record form for the Private Education Retirement Annuity Association Fund. It explains that the form collects identifying and employment information as well as beneficiary details. It is used to establish a member's permanent record and for processing claims. Beneficiaries can be designated as primary or contingent.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    PERAA Fund ATTACH

    MEMBER'S 1x1 TIN Number PERAA ID NUMBER


    (For PERAA use only)
    RECORD (MR) LATEST PHOTO

    PLEASE READ INSTRUCTIONS PRINTED NAME


    AT THE BACK BEFORE FILLING AT THE BACK
    UP THE FORM

    Surname Given Name Middle Name Date of Birth


    Mo. Day Year

    Sex Male Civil Status Single Widow/Widower Place of Birth


    Female Married Separated

    Permanent Mailing Address (No. & Street, City/Town/Province) Tel. No.


    Mobile No.
    Email Address

    BENEFICIARIES
    Write the names of your beneficiary/ies below. Unless specified in the Remarks column, your designated beneficiary/ies will be considered Primary.
    Please refer to the details at the back of the form for guidance.
    Name Date of Birth Relationship to You Remarks
    Mo. Day Year

    In case of minor beneficiary/ies (ages below 18), please assign a guardian NAME OF GUARDIAN
    who shoud be over 18 years of age (excluding yourself).
    Relationship to minor

    TO BE FILLED OUT BY EMPLOYER


    Present Employer: Name
    (Institution) Address Tel. No.

    Date of Employment Date of PERAA Coverage Status of Employment Position/Title (Specify)


    Mo. Day Year Mo. Day Year
    Full Time 1. Academic
    Part Time 2. Non-Academic

    Certified Correct By: (For School's Authorized Signatory only ) Name Position
    (Signature over printed name)

    I hereby certify that all information above are true and correct, understood by me and that I bind myself to all the provisions of
    PERAA Plan Resolution and other related documents. Also, I understand and agree that by signing herein, I voluntarily
    authorized and consented to the use, disclosure and processing of my Personal Data to PERAA Fund which shall in turn will (FOR PERAA USE ONLY)
    preserve the confidentiality of the information provided pursuant to the provisions of the Republic Act No. 10173 or the Data
    Privacy Act of 2012.

    Member's Thumbmark

    LEFT
    Signature over Printed Name Thumbmark
    DATE RECEIVED:

    RIGHT By:
    Thumbmark
    Date Accomplished
    The Member's Record (MR)
    1. Employees should first be eligible for membership (under Retirement Plan Resolution - RPR) and must be covered
    in the Remittance List before they are required to accomplish this form in duplicate (one for PERAA Fund file and
    one for employee).

    2. The MR is the member's permanent record in PERAA Fund under his present employer. In case of transfer to
    another Participating Institution, the member, upon eligibility, should accomplish a new MR.

    3. The MR is the basis for the issuance of membership ID card.

    4. The MR is a requisite for processing a member's benefit claims. Failure to submit this form will result in the
    disqualification of the member's beneficiaries from the Minimum Death Benefit (MDB) grant.

    5. Under the Remarks column of the Beneficiary Information, a member may designate his/her beneficiary/ies as
    Primary or Contingent.

    ▪ In case of member's death, the primary beneficiary/ies will receive the benefit.
    ▪ In the event of death of all primary beneficiary/ies, the contingent beneficiary/ies will receive the benefit, if any.

    6. A member may change his/her beneficiary/ies by accomplishing the Change or Addition Form.

    Private Education Retirement Annuity Association Fund


    16/F Multinational Bancorporation Centre
    6805 Ayala Avenue, Salcedo Village, Makati City 1227

    Tel. No. (02) 8817-4531, 8817-4544 • Fax No. (02) 8818-7921, 8889-9884
    E-mail: [email protected] • [email protected]

    Revised October 2020


    10,000 copies

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