AFPMBAI Grade Application

ARMED FORCES AND POLICE MUTUAL BENEFIT ASSOCIATION, INC.
GRAnts for DEpedents (GRADE) Program
APPLICATION FORM
 Please fill out this form and attach with all other requirements.
 Print all entries legibly and avoid erasures.
 Submit to the nearest AFPMBAI Office or mail it to 4th Flr. Social Services Office, AFPMBAI Bldg.,
Col. Bonny Serrano Rd. cor EDSA, Quezon City.
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STUDENT’S PERSONAL DATA
Last Name: _______________________________________

2” x 2”
Picture
First Name: _______________________________________
Middle Name: _____________________________________ Print name on the
back and staple here.
Date of Birth: Month: ______ Day: ______ Year: __________
Age: ___ Sex: ___ Civil Status: ___ Religion: ____________
City Address: _______________________________________________________________
Tel. No.: ________________________ Cellphone No.: ____________________________
Email Address: ______________________________________________________________
Provincial Address: __________________________________________________________
College/University intended to enroll in: ________________________________________
Address: ___________________________________________________________________
Year Level: ___________ Degree/Course: _______________________________________
FAMILY BACKGROUND
Name of Member (Last, First, Middle): __________________________________________

Branch of Service: __________________ Rank: ___________________________________
Date of Death: _________________ Relation to applicant: _____________________
Name of Surviving Parent/Guardian (Last, First, Middle): ___________________________
Address: ___________________________________________________________________
Occupation: _______________________ Company: _______________________________
Relation to applicant: ___________ Tel. No.: ___________ Cellphone No.: ____________
List all other members of the family:
Name: Age: Relation: Company/School:
____________________________ ____ _____________ ________________________
____________________________ ____ _____________ ________________________
____________________________ ____ _____________ ________________________
____________________________ ____ _____________ ________________________
____________________________ ____ _____________ ________________________
____________________________ ____ _____________ ________________________
Page 1 of 2
ARMED FORCES AND POLICE MUTUAL BENEFIT ASSOCIATION, INC.
GRAnts for DEpedents (GRADE) Program
EDUCATIONAL BACKGROUND
High School: ____________________________ Address: ____________________________
Inclusive Dates (from/to): _____________________________________________________
Awards: ___________________________________________________________________
___________________________________________________________________________
Organizations & Position held: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Elementary School: ______________________ Address: ____________________________
Inclusive Dates (from/to): _____________________________________________________
We hereby certify to the truthfulness and completeness of the information on this form and that all
documents attached are authentic. We understand that any misinformation and/or non-declaration of
information and/or falsification of documents will be grounds for automatic disqualification from the
Program. By signing this form, we also authorize AFPMBAI or its representative to verify the veracity and
accuracy of all the information in this form.
_____________________________________ ________________________
Applicant’s Signature over Printed Name Date
_____________________________________ ________________________
Parent/Guardian’s Signature over Printed Name Date
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DOCUMENTARY REQUIREMENTS
PLEASE COMPLETE ALL THE DOCUMENTS AND ATTACH THEM IN PROPER SEQUENCE.
1. Duly accomplished Application Form with 2 7. NSO certified Marriage Contract of parents of
copies of 2x2 picture of applicant taken applicant, if applicant is the child or NSO-
within the last 3 months. certified certificate of no marriage and
2. Proof of highest educational attainment such affidavit of no child of the member, if
as report cards, true copy of grades/ applicant is the sibling.
transcript of records duly certified by the 8. Barangay, NBI & Local Police Clearance
school principal/registrar. 9. Duly notarized certification of legally adopted
3. For incoming first year, entrance examination child for married/unmarried member or
result or certificate from school that the legally adopted brother/sister for single
applicant passed the requirements and is member.
ready for enrollment. Registration or 10. Duly notarized certification that the applicant
Assessment Form for incoming second year has not applied or received any other
college student. scholarship grant or financial assistance at
4. Course curriculum. the time of application.
5. Certificate of Good Moral Character from 11. Declaration of legal beneficiaries,
High School Principal for incoming college authenticated copy of death certificate, spot,
freshman or Guidance Counselor/College casualty and posthumous report of deceased
Dean for incoming sophomore. member.
6. NSO certified birth certificate of applicant.
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ARMED FORCES AND POLICE MUTUAL BENEFIT ASSOCIATION, INC.

GRAnts for DEpedents (GRADE) Program

Last Name: _______________________________________

Name of Member (Last, First, Middle): __________________________________________

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