AFP RETIREMENT AND SEPARATION BENEFITS SYSTEM

424 Capinpin Avenue, Camp General Emilio Aguinaldo, Quezon City

Telephone Number 911-0194

ADVANCE REFUND PROGRAM APPLICATION FORM

IMPORTANT: PLEASE READ INSTRUCTION AND TERMS AND CONDITIONS AT THE BACK BEFORE
FILLING OUT THIS FORM
Direct or indirect commission of fraud, collusion, falsification, misrepresentation of facts or any other kind of
WARNING: anomaly in the accomplishment of this form, or in obtaining any benefit or payment under this application, shall be
subject to civil and/or criminal sanction.
Kindly fill-up those with (*)asterisk
*LAST NAME *FIRST NAME *MIDDLE NAME

*RANK *AFP SERIAL NUMBER *BR OF SVC *ASSIGNMENT IN THE AFP

*PERMANENT ADDRESS *TELEPHONE NUMBER

*MOBILE PHONE NUMBER

(This portion is to be filled up by AFP RSBS Personnel)

TOTAL AMOUNT TO BE ADVANCED:
IN FIGURES IN WORDS

COMPUTATION OF NET PROCEEDS:

RATE OF TERM TOTAL AMOUNT TO BE LESS: AMOUNT NET AMOUNT IN WORDS
DISCOUNT FINANCED OF DISCOUNT PROCEEDS

Evaluated for Approval: Recommended for Approval: Endorsed for Approval: Approved:

LOAN OFFICER, MRSD HEAD, MRSD, MG HEAD, MG EVP/COO

Date: ____________________ Date: _____________________ Date: ____________________ Date: _______________________

APPLICATION/ AGREEMENT

I hereby apply for the Advance Refund of my contribution in the amount of

P___________________. In consideration thereof, and in accordance with the Terms and
Conditions printed at the back hereof, which I have read and understood clearly and to which I bind
myself to pay the correct total amount due hereon through deduction from my total refundable
amount, I hereby authorize the AFP RSBS to automatically deduct any outstanding loan from my
total accumulated contribution upon qualification to refund.

LEFT THUMB RIGHT THUMB MARK

MARK CLIENT
( SIGNATURE OVER PRINTED NAME)

DATE APPLIED

AR Form 1
 INSTRUCTIONS
Submit only one properly accomplished application form. Application and supporting papers with
erasures or alterations will not be accepted

DOCUMENTATION REQUIREMENTS
GENERAL GUIDELINES

o All Retiring Military Personnel of the AFP with approved Order of

Retirement whose entitlement is at least one (1) month prior to the date of
retirement but not exceed twelve (12) months.
o Loanable amount shall be equivalent to the net refundable contributions to
RSBS as of the date of advance refund application.
TERMS AND o Eligibility to borrow shall be twelve (12) months or less before the
CONDITIONS retirement date.
o Discount rate of one percent (1%) per month.
o Term of one (1) month to twelve (12) months.
o Outright deduction of outstanding loan from total refundable amount.

o Duly accomplished Loan Application Form.

Checked/ Reviewed by:
SIGNATURE OVER PRINTED NAME
DATE
o Duly accomplished Borrower’s Information Sheet with 2x2 size pictures of
the Borrower in complete military uniform (breast level showing name
plate) and his/ her spouse.
o Original or Authenticated Copy of Retirement Order from the AFP.
o Original or Authenticated Copy of Latest Statement of Service indicating
purpose “For RSBS Reference”.
o Original or Authenticated Copy of Certificate/Statement of Last Payment.
o Original copy of Latest One-Month Pay slip or Statement of Earnings and
Deductions duly signed by the AFP/ Major Service Finance Center.
o Duly signed and notarized Deed of Assignment with authority to deduct
signed by the Borrower and his/ her Spouse.
o NSO issued Marriage Contract and CENOMAR with Official Receipt.
o Original and photocopy (back to back) of two (2) valid IDs of the borrower
with picture and three (3) specimen signatures of the Borrower and Spouse
affixed on the photocopy. IDs shall be any two (primary and secondary) of
the following:
Primary Valid IDs Secondary Valid IDs
AFP Active Military ID SSS ID PHILHEALTH ID HDMF ID
AFP Military Dependent’s ID GSIS ID PRC ID PASSPORT
BIR TIN ID COMPANY ID COMELEC ID
LTO driver’s License
Other IDs issued by the government or any AFP
Financial Institution with signature and photo of the
Borrower/ Spouse.

MODE o To be deducted from the total refundable amount upon qualification to

OF refund.
PAYMENT
Note:
o Photocopied documents must be authenticated by authorized officer of Major Service issuing unit.
o Computation of Refund Differentials will be on the Day of Retirement Claimants are required to
submit photocopy or their Last Pay Slip and Retiree’s Identification Card

AR Form 1