Burial Assistance Application Form

Version 14.
0 November 4, 2022 Control Number: FT-PAD-01
Burial Assistance Application Form

11th Floor Robinsons Cybergate Plaza, EDSA corner
Pioneer St., Mandaluyong City
Contact # (02) 8370-1716; 8370-1719
Email Address: [email protected]
Date of Interview Date of Interment

Record No. Note: Maximum Assistance that can be provided by OVP is ₱5,000
and only before burial or interment.
Name of Deceased FIRST NAME MIDDLE NAME LAST NAME
Occupation Educational Attainment
Date of Death MONTH, DAY, YEAR Age Sex Total Cost of Funeral Contract
Male Female
Details of Authorized Representative

The representative must be listed as an immediate family member of the deceased in the DSWD, CSWDO, MSWDO Social Case Study Report
Name of Authorized FIRST NAME MIDDLE NAME LAST NAME

Representative
Relationship to Age Sex Contact Number

the Deceased Male Female
Address E-mail Address
Pursuant to the Data Privacy Act of 2012 (Republic Act 10173), I hereby give my consent to the Office of the Vice President
(OVP) to process my personal information and sensitive personal information for my application for burial assistance. I understand
that the processing shall be limited to the purpose specified.
Ako si _____________________________________, (representative), ay

nangangako na ang lahat ng impormasyon at dokumentong aking isusumite
ay tunay at totoo. Naiintindihan ko na ang aking ipinasang aplikasyon ay
dadaan muna sa pagsusuri upang makumpirma ang katunayan ng mga
dokumento.
SIGNATURE OVER PRINTED NAME
OF AUTHORIZED REPRESENTATIVE
Anumang mapatunayang kasinungalingan o pag gamit ng mga pekeng
dokumento ay magdudulot ng disqualification o pagkansela ng aplikasyon
para sa Burial Assistance Program at maaaring magresulta sa criminal o civil DATE
liability gaya ng pagkakulong at multa.
Evaluation TO BE FILLED OUT BY OVP PERSONNEL
FOR COMPLETION OF REQUIRED DOCUMENTS Processed by

Please return on: Actual Date of Return:
Details/Instructions to be placed on the checklist at the back of this form.
RECOMMENDED FOR APPROVAL

SIGNATURE OVER PRINTED NAME
has submitted complete, valid, and updated documentary requirements (per OF PAD STAFF
checklist at the back page)
DATE
DENIED
Invalid/Non-compliant Documents
Already Buried/Interred
Others: ____________________________
PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO

AY LIBRE AT WALANG BAYAD.
Requirements Conditions
1. Original copy of the filled-out Burial - Dated and signed prior to the interment
Application form (See Annex C), - Dated and signed within 1 week from the date of
signed by the Authorized death for Muslims and COVID cases
Representative - Applications received beyond the said period shall
not be eligible for assistance.
2. Original copy of the Social Case Social Case Study Report should be issued by a
Study Report or Certificate of DSWD, PSWDO, CSWDO, or MSWDO Social
Indigency/ Eligibility Worker and addressed to the OVP
Alternative: Certificate of Indigency/Eligibility

issued by the PSWDO/CSWDO/ MSWDO where the
client resides. Must state that the client is in need of
burial assistance.
3. Photocopy of Registered Death - With registry number. In the absence of registry
Certificate number, Death Certificate issued by the Hospital,
or the Municipal/ City Health Officer shall be
accepted.
4. Photocopy of at least one (1) valid - Valid as of the date of the interview
Identification Card of Deceased - Original must be presented
and Authorized Representative - Front and back of the card were photocopied
List of Valid IDs:

● Driver’s License
● Solo Parent ID
● NBI Clearance / ID
● TIN ID
● Passport
● UMID/GSIS/SSS ID
● PhilHealth ID
● Voter’s Certification
● Police Clearance / ID
● 4Ps ID
● PRC ID
● Postal ID
● PWD ID
● Senior Citizen ID
● Barangay ID
● Philippine Identification System (National ID)
Alternative ID in case of recent flood, fire or

insurgency in the area or other justifiable
circumstances:
● Barangay Certification
● Explanation/ Certification of the Satellite Lead
Alternative ID for the Deceased:

● Registered Birth Certificate
● Fetal Death Certificate
PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO

AY LIBRE AT WALANG BAYAD.

Burial Assistance Application Form

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Version 14.

0 November 4, 2022 Control Number: FT-PAD-01

Burial Assistance Application Form

Date of Interview Date of Interment

Name of Deceased FIRST NAME MIDDLE NAME LAST NAME

Occupation Educational Attainment

Details of Authorized Representative

Name of Authorized FIRST NAME MIDDLE NAME LAST NAME

Relationship to Age Sex Contact Number

Address E-mail Address

Ako si _____________________________________, (representative), ay

Evaluation TO BE FILLED OUT BY OVP PERSONNEL

FOR COMPLETION OF REQUIRED DOCUMENTS Processed by

Details/Instructions to be placed on the checklist at the back of this form.

RECOMMENDED FOR APPROVAL

PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO

Alternative: Certificate of Indigency/Eligibility

List of Valid IDs:

Alternative ID in case of recent flood, fire or

Alternative ID for the Deceased:

PAALALA: LAHAT PO NG MGA PORMA AT PROGRAMA NG TANGGAPAN NG PANGALAWANG PANGULO

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