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Death Benefit Claims Form: Republic of The Philippines Ilocos Norte Provincial Operations Office

Michael M. Menor is filing a death benefit claim as the son of the deceased Villamor B. Menor, who served as a Barangay Kagawad in Brgy. 22 Nagbacalan, Paoay, Ilocos Norte until his death on February 3, 2019. The claim form requires documentation including a death certificate, certificates of incumbency from the DILG and Punong Barangay, and Michael's birth certificate to prove his relationship. The municipal mayor and claimant certify the accuracy of the information provided. A separate certification also confirms Villamor B. Menor's position and dates of service as Barangay Kagawad before his death.

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Alta Grace Manuel Madarang
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855 views2 pages

Death Benefit Claims Form: Republic of The Philippines Ilocos Norte Provincial Operations Office

Michael M. Menor is filing a death benefit claim as the son of the deceased Villamor B. Menor, who served as a Barangay Kagawad in Brgy. 22 Nagbacalan, Paoay, Ilocos Norte until his death on February 3, 2019. The claim form requires documentation including a death certificate, certificates of incumbency from the DILG and Punong Barangay, and Michael's birth certificate to prove his relationship. The municipal mayor and claimant certify the accuracy of the information provided. A separate certification also confirms Villamor B. Menor's position and dates of service as Barangay Kagawad before his death.

Uploaded by

Alta Grace Manuel Madarang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT


Ilocos Norte Provincial Operations Office

DEATH BENEFIT CLAIMS FORM

NAME OF DECEASED BRGY OFFICIAL : VILLAMOR B. MENOR

Address : BRGY. 22 NAGBACALAN, PAOAY, ILOCOS NORTE

Position : BARANGAY KAGAWAD

Date Elected/Appointed : MAY 14, 2018

Name of Claimant : MICHAEL M. MENOR

Relationship : SON

Address : BRGY. 22 NAGBACALAN, PAOAY, ILOCOS NORTE

(PLEASE ACCOMPLISH AND SUBMIT TOGETHER WITH THE FOLLOWING AUTHENTICATED DOCUMENTS)

/ 1. Death Certificate

/ 2. Certificate of Incumbency issued by the DILG Officer

/ 3. Certificate of Incumbency issued by the Punong Barangay

4. Marriage Certificate if claimant is widow/er

/ 5. Birth Certificate of the Claimant to show proof of relationship to the deceased


Barangay Official from the Local Civil Registrar (if sibling is the claimant)
6. If single, Birth Certificate of the deceased or affidavit of two disinterested parties
(if claimant is a parent)

7. Appointment id the deceased is an Appointive Barangay Official

/ 8. Oath of Office of the deceased Barangay Official

CERTIFICATION

I HEREBY CERTIFY that the deceased Barangay Official was indeed the person who served as
BARANGAY KAGAWAD in BRGY. 22 NAGBACALAN, Paoay up to the time of his death.

EILEEN LL.GUERRERO, MD
Municipal Mayor
Date: February 22, 2019

I HEREBY CERTIFY to the correctness of information and genuineness of the above submitted
documents.

_______________________________
Printed Name & Signature of Claimant

Date: ________________

“Matino, Mahusay at Maaasahan”


D. Samonte St., Brgy. 7-B, Laoag City
Telephone Number (077) 772 3003 • 772 0354 • 772 0134
dilg_in@yahoo.com
Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
Ilocos Norte Provincial Operations Office

CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that based on records on-file in this office, MR.


VILLAMOR B. MENOR was an incumbent BARANGAY KAGAWAD of Barangay
#22 Nagbacalan, Paoay, Ilocos Norte.

Certifying further that MR. MENOR had rendered services in the barangay
with the following details:

Position Held Date of Term Inclusive Dates


Election of From To
Office
Barangay May 14, 2018 9 May 14, 2018 February 3,
Kagawad month 2019
s

This certification is issued upon the request of MR. MENOR, his son, for
whatever legal intents and purposes it may serve.

Given this 22nd day of February 2019 at Paoay, Ilocos Norte.

ALTA GRACE MADARANG-HILARIO


MLGOO

“Matino, Mahusay at Maaasahan”


D. Samonte St., Brgy. 7-B, Laoag City
Telephone Number (077) 772 3003 • 772 0354 • 772 0134
dilg_in@yahoo.com

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