ARMED FORCES OF THE PHILIPPINES EDUCATIONAL BENEFIT SYSTEM OFFICE (AFPEBSO)
Gen. Enrile cor. Gen. Ramos Avenues, Camp General Emilio Aguinaldo, Quezon City Phone: (02) 912-6922; (02) 911-6153; (02) 421-7607 / Fax: (02) 912-9606 / CATEX: (774) 8724; (774) 6009 Website: www.afpebso.org.ph
APPLICATION FORM
Read the instructions carefully. All blanks should be filled up. Please print or write legibly. INSTRUCTIONS: 1. Fill-up all applicable entries of this Application Form and place NA if not applicable. 2. Attach all supporting documents to the accomplished Application Form (see back of this form). 3. Submit to the Customer Service Staff in-charge of the area (Luzon, NCR, Visayas, Mindanao).
INFORMATION OF APPLICANT
1. AREA: Luzon 2. NAME OF APPLICANT: NCR Visayas Mindanao
(Surname) (First Name) 3. RELATIONSHIP TO AFP / CAA MEMBER: 4. CURRENT MAILING ADDRESS: City Address: Phone: Provincial Address: Phone: Cell phone: Email address: 5. DATE OF BIRTH: 6. PLACE OF BIRTH: 7. SEX: Male Female 8. CIVIL STATUS: 10. SCHOOL INTENDED TO ENROLL IN: 11. SCHOOL ADDRESS: 12. EDUCATIONAL LEVEL: ELEM HS College 13. YEAR LEVEL: 14. COURSE: 14. EDUCATIONAL BENEFIT PROGRAM APPLIED FOR:
(Middle Name)
LATEST 2x2 PHOTO OF APPLICANT
(Make sure your full name is written on the back for identification should the photo become accidentally detached.)
9. RELIGION:
Post-Graduate
Tech/Voc
Short Course
INFORMATION OF AFP / CAA MEMBER
1. AFP / CAA MEMBER: (Surname) (First Name) (M.I.) (Rank) (AFP SN) (Branch of Service) 2. MILITARY STATUS: KIA CDD (Combat) CDD (Non-Combat) Deceased LOD Active Soldier With Disability 3. DATE OF DEATH / CDD: 4. PRESENT (for active) or LAST (for CDD) UNIT ASSIGNMENT: 5. CURRENT MAILING ADDRESS: Phone: Cell phone: Email address: 6. DATE OF BIRTH: 7. PLACE OF BIRTH: 8. SEX: 10. NR. OF DEPENDENTS: Male Female 9. CIVIL STATUS: NAME OF LEGAL DEPENDENTS: AGE: YEAR LEVEL: EDUCATIONAL PROGRAM AVAILED: 1. 2. 3. 4. 5.
INFORMATION OF APPLICANTS GUARDIAN (if applicable)
1. NAME OF GUARDIAN: (Surname) 2. RELATIONSHIP TO APPLICANT: 3. CURRENT MAILING ADDRESS: City Address: Provincial Address: Email Address: (First Name) (Middle Name)
Phone: Phone: Cell Phone:
It is understood that the information supplied above are true and correct to the best of my knowledge. Any false entry herein shall be a ground for the disqualification and/or termination of the educational benefit grant.
SIGNATURE OF APPLICANT (Over Printed Name) Received by AFPEBSO Personnel (Name & Signature): Date Received:
SIGNATURE OF AFP/CAA MEMBER OR GUARDIAN (Over Printed Name)
LIST OF REQUIREMENTS FOR APPLICANTS OF AFP EDUCATIONAL BENEFITS For Military Dependents (1st to 3rd Priorities)
Dependents Children, in the case of married military personnel; Siblings (bother or sister), in the case of unmarried military personnel.
Basic Requirements: Duly accomplished AFPEBSO Application Form Two (2) copies of latest 2x2 picture of applicant Certificate of Live Birth of Applicant issued by NSO or LCR Marriage Contract of Applicants parents issued by NSO or LCR Notarized Declaration of Legal Beneficiaries by the AFP or CAA member Latest Appointment Order (for CAFGU AA) Latest Report Card/ Student Record Form 138 for elementary or high school students Transcript of Records for college students Copy of highest Diploma (Elem or High School) Certificate of Enrolment (Elem or High School) Registration Card/Certificate (current College students) st College Admission/Placement Exam Result (for incoming 1 Year college) Additional Requirements: a. If parent is deceased (Killed in Action or died in Line of Duty): Death Certificate (certified true copy or authenticated copy) Casualty Report (certified true copy or authenticated copy) Posthumous Separation Order (certified true copy or authenticated copy) b. If parent is discharged with CDD (with disability rating of 100% due to wounds or sickness acquired while in the service): Separation Order (certified true copy or authenticated copy) PVAO Certification of 100% CDD Rating Spot Report/After Battle Report (for CDD, battle-related) c. If parent is still on active duty: DLO Clearance or Certificate of Non-pending case of parent Enlisted Personnel - Latest Reenlistment Order (original/ certified true copy/ authenticated copy) Officer (if Reserve) Latest ETAD or SOT Order (certified true copy/ authenticated copy) d. Other requirements (case-to-case basis): Certification of Grades from the Registrar Certification of Scholarship Expenses Original Official Receipt for previous payment made by AFPEBSO Statement of Account / Assessment of payment for school year or semester Valid and confirmed LBP ATM Account Signed Scholarship Certificate or Certificate of Undertaking or Scholarship Agreement Investigation Report
For Active Military Personnel applying for educational benefit (4th & 5th Priorities)
Basic Requirements: Duly accomplished Application Form Two (2) copies of latest 2x2 picture of applicant Latest Report Card/ Student Record High School Form 138 College Level Transcript of Records Copy of Highest Diploma (HS or College) Registration Card/Certificate (current College students) st College Admission/Placement Exam Result (incoming 1 Year college) Additional Requirements: a. For Active military personnel (P1 or P2): EP- Latest Reenlistment Order (original/certified true copy/authenticated) Officer (if Reserve) Latest ETAD or SOT Order (certified true copy/authenticated) DLO Clearance or Certificate of Non-pending case Clearances from TJAG, TIG and TPMG Letter of Recommendation from Commanding Officer Updated Summary of Information Latest Officer Evaluation Report (Officers) or EP Evaluation Marks (for EP) with a minimum performance rating of Very Satisfactory for the last 3 Rating Periods b. For Active military personnel with Disabilities: All requirements of applicable to Active (P1 or P2); and Certification of Physical Profile with sound neuro-psychological capacity to study issued by the AFP Medical Board and with orders from The Adjutant General -o-0-o-
