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Corporate Planning Group and Operations Sector

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Corporate Planning Group and Operations Sector Powered By Docstoc
					                 Prepared by:
Corporate Planning Group and Operations Sector
Government Service Insurance System
Financial Center
Pasay City, Metro Manila

Telephone: (+632) 479-3645
Email: crmd@gsis.gov.ph; gsismail@gsis.gov.ph
GSIS Citizen’s Charter 2011                                                    GSIS Citizen’s Charter 2011                             1


       GSIS Home, Regional, Branch, and Satellite Offices:

Offices                      Address
                                                                                                   GSIS Vision
Home               GSIS Bldg., Financial Center, Pasay City

Regional (16)                                                                                      In the next five years,
 Quezon City       M. Geronimo Bldg. 746 Mindanao Ave. T. Sora, Quezon City     we will rebuild the Government Service Insurance System
 Dagupan           PNR Site, Mayombo District, Dagupan City, Pangasinan
 Laoag             Brgy. 23 P. Paterno St., Vintar Road, Laoag City
                                                                                          as the premier pension fund institution
 Tuguegarao        Carig, Tuguegarao City                                           and as a center for providing world-class service
 Batangas          Brgy. Alangilan, Batangas City
 Naga              Brgy. Del Rosario, Naga City
                                                                                                       to its members.
 Pampanga          McArthur Highway, Sindalan, San Fernando City, Pampanga
 Cebu              Leon Kilat Street, Cebu City                                                GSIS will be an organization
 Iloilo            Corner Sto. Rosario and Zamora Sts., Iloilo City
 Tacloban          Marasbaras, Tacloban City, Leyte                                          that is transparent, autonomous
 Bacolod           Araneta St., Brgy. Tangub, Bacolod City                                     and beyond public reproach.
 Butuan            Libertad, Butuan City
 Cagayan De Oro    Carmen, Cagayan De Oro City

                                                                                                  GSIS Mission
 Davao             McArthur Highway, Matina, Davao City
 General Santos    Lido Bldg., Santiago Blvd., General Santos City
 Zamboanga         Moret Field, Baliwasan, Zamboanga City

Branch (25)
 Bulacan           Cabanas, KM 45, McArthur Highway, Longos, Malolos City
                                                                                            To regain the trust and confidence
 Laguna            Brgy. Biñan, Pagsanjan, Laguna                                               of our stakeholders, we will
 Palawan           National Highway, Brgy. San Miguel, Puerto Princesa City
 Baguio            3/F EDY Bldg., Kisad Road, Baguio City
                                                                                    singularly pursue the social mission of our Charter
 La Union          2/F Bugayong Bldg., Sevilla, San Fernando, La Union         and promote an efficient organization that is fully-automated
 Bayombong         Dumlao Stadium, Clisoc Field, Bayombong, Nueva Vizcaya                          and member-focused.
 Cauayan           Tagaran, Cauayan City, Isabela
 Bataan            San Ramon Highway, Dinalupihan, Bataan
 Cabanatuan        NFA Compound, Maharlika Highway, Cabanatuan City                        We will relentlessly pursue continual
 Tarlac            Urquico Oval, San Roque, Tarlac City
 Lucena            Maharlika Highway, Iyam, Lucena City                                   improvement in our services driven by
 Legazpi           Co Bldg., Alternate Road, Bltano, Legazpi City                              integrity, professionalism,
 Sorsogon          Flores St., Capitol Compound, Sorsogon City
 Bohol             2/F CPG North Ave., Tagbilaran City
                                                                                             and a culture of public service.
 Roxas             Belo St., Roxas City
 Catbalogan        Mabini Ave., Catbalogan, Samar                                         We will sustain the financial viability
 Maasin            Demeterio St., Abgao, Maasin City, Southern Leyte
 Dumaguete         National Highway, Daro, Dumaguete City                               of the System and ensure its prolonged
 Surigao           Yuipco Bldg., Borromeo St., Surigao City                               actuarial life, for the benefit not only
 Iligan            Tubod Highway, Iligan City, Lanao Del Norte
 Kidapawan         Quezon Boulevard, Kidapawan City
                                                                                         of our existing members, but also the
 Tagum             Sobrecarey St., Tagum City                                          next generation of government employees.
 Cotabato          Governor Gutierrez Ave., Cotabato City
 Pagadian          Corner F. Pajares and V. Sagun Sts., Pagadian City
 Dipolog           Minaog, Dipolog City                                                     We will restore the pride of GSIS
                                                                                             so as to retain and recruit staff
Satellite (18)
 Vigan, Ilocos Sur         Candon, Ilocos Sur         Iba, Zambales
                                                                                              that share our commitment.
 Baler, Aurora             Calapan, Or. Mindoro       Mamburao, Occ. Mindoro
 Boac, Marinduque          Daet, Camarines Norte      Virac, Catanduanes
 Masbate (Masbate City)    Antique (San Jose)         Aklan (Kalibo)
                                                                                          Finally, we will endeavor to empower
 Borongan, E. Samar        Catarman, N. Samar         Ormoc (Ormoc City)               our members to enable them to participate
 Tandag, Surigao del Sur   Malaybalay, Bukidnon       Basilan (Isabela City)                in the evolution of our institution.
  GSIS Citizen’s Charter 2011                                                2


                      PROCESSING TIME COMMITMENTS
           TRANSACTION                       PROCESSING TIME (working days)

For Active GSIS Members:
 Creation of Member’s Record                                  15
 Updating of Member’s Record                                  15
 Release of GSIS eCard (nationwide)                           10
                                              (after receipt of the eCard from
                                                         UnionBank)

 Reconciliation of Member Account                             60
 [Premium and Loan Payments]

 Processing of Retirement and Cash               On the date of retirement
 Surrender Value (CSV)/Termination        (Provided that all requirements are
 Value (TV) for Life Claim Applications   submitted to the GSIS ninety (90) days
                                          prior to the effective date of the
                                          retirement)

                                                           90 days
                                          (In case all requirements are submitted
                                          to the GSIS on the date or after the
                                          effective date of retirement)
 Processing of Separation Claim                  On the date of separation
 Applications                              (Provided     that all requirements are
                                          submitted    to the GSIS ninety       (90)
                                          days prior    to the effective date of the
                                          separation   from service)

                                                           90 days
                                          (In case all requirements are submitted
                                          to the GSIS on the date or after the
                                          effective date of separation)
 Processing    of   Compulsory    and                         60
 Optional Life Insurance Benefits (i.e.   (upon receipt of complete documents)
 Cash Surrender Value/Termination
 Value, Death Benefit)
 Processing      of     Unemployment                          60
 Benefits                                 (upon receipt of complete documents)
 Processing of Disability Benefits                            60
                                          (upon receipt of complete documents)


 Processing of Employees                                      60
 Compensation (EC) Benefits                (upon receipt of complete documents)


 Processing of Funeral Benefits                               60
                                          (upon receipt of complete documents)
  GSIS Citizen’s Charter 2011                                           26               GSIS Citizen’s Charter 2011                                          3


                                                                                                 TRANSACTION                   PROCESSING TIME (working days)
    TRANSACTION                  DOCUMENTARY REQUIREMENTS
IX. PRE-NEED                EDU-CHILD AVAILMENT                                       Processing of Survivorship Benefits                     60
                                                                                                                             (upon receipt of complete documents)
                                 GSIS Pre-need application form
                                 Pre-Need Program Application for Plan                Processing of Consolidated Loan                          3
                                  Conversion and for Other Benefits Under              (Consoloan) Applications availed
                                                                                       thru the GSIS eCard
                                  the Plan (college education benefit)
                                                                                       (after approval by the       Agency
                                 Original & Xerox copy of Certificate of              Authorized Officer or AAO)
                                  Full payment
                                                                                       Processing of Emergency Loan                             3
                                 Original & Xerox copy of Plan Agreement
                                                                                       Applications availed thru the GSIS
                                 Original & Xerox copy of Registration                eCard
                                  Card indicating the number of units &                (after approval by the       Agency
                                  subjects enrolled and paid by the scholar            Authorized Officer or AAO)
                                  for the semester which will be claimed for
                                  reimbursement .                                      Processing     of    Policy   Loan                       3
                                 Original    & Xerox      of Assessment/              Applications availed thru the GSIS
                                  Schedule of fees                                     eCard
                                                                                       (after approval by the       Agency
                                 Original & Xerox copy of Course                      Authorized Officer or AAO)
                                  Curriculum indicating the number of units
                                  & subjects to be taken by the scholar for            Processing of Cash Advance availed                       3
                                  the whole course (1st year up to 4th                 thru the GSIS eCard
                                  year).                                               (after approval by the       Agency
                                 Original & Xerox copy of Official Receipts           Authorized Officer or AAO)
                                  (of payment to school/s)                             Receipt of Payment (over-the-                     Within the day
                                                                                       counter) through the GSIS Cash
                      Note: in case the member is requesting that the amount be
                      paid to another person, then he/she must show Deed of
                                                                                       Receipting Facility
                      Assignment and/or Transfer of Rights executed by the
                                                                                       Preparation of Final Statement of                       60
                      Plan-holder
                                                                                       Account (SOA) (for Housing Loans)
                            HOSPITALIZATION INSURANCE PLAN (HIP)                      Preparation of Deed of Absolute                         90
                                 GSIS Hospital Insurance Claim Form                   Sale/ Affidavit of Release of
                                                                                       Mortgage and Releasing of Title
                                 Original Copy of HIP Policy Contract
                                 Certified True copy of statement                of   Processing        of   Retirement                        3
                                  Hospitalization Account                              Certification for GSIS Members who
                                 Official Receipts/Charge Slips                       retired (except those who retired
                                                                                       under RA 1616)
                                 Admitting History or Medical Abstract
                                                                                       Processing  of     Certification of                      3
                            CEAP                                                      Premiums Paid for GSIS Members
                                 1st Annual Allowance:                                applying under Portability Law,
                                                                                       after reconciliation of premium
                                     Letter request for allowance                     payments.
                                     Original copy of CEAP Policy Contract
                                                                                       Response to members’ complaints,      Within 10 working days from receipt of
                                     Original copy of Birth Certificate of
                                                                                       requests or queries (including        the complaint, request or query by the
                                      grantee/scholar (NSO copy) (in case              requests   for   Statement    of               GSIS Operating Unit
                                      not yet registered, late NSO registration
                                      can be filed)                                    Member’s Account or SOMA)
                                                                                                                              (Note: Requests for reconciliation of
                                                                                                                              accounts are not included in the 10-
                                 Succeeding Annual Allowance:
                                                                                                                                 working days processing time)
                                   Letter request for allowance (indicate
                                      policy number)                                   Processing of     Pre-Need    Claim                     60
                                                                                       Applications                            (upon receipt of complete documents)
   GSIS Citizen’s Charter 2011                                                  4           GSIS Citizen’s Charter 2011                                       25


           TRANSACTION                       PROCESSING TIME (working days)                     TRANSACTION                   DOCUMENTARY REQUIREMENTS

For GSIS Pensioners / Inactive Members:                                                VIII. EC Claims                    detail the circumstances of the accident:
                                                                                              Under PD 626                time, place, date and reasons or purpose for
                                                                   th
 eCrediting of Monthly Pension              Not later than the 8        of the month                                      being at the place of incident
                                                                                       (Note: All EC Claims should
 Processing of Pension Accruals (for                        3                          have medical report from
                                                                                                                         Certified copy of Police Investigation
 submission to UBP for eCrediting)                                                     Medical Evaluation and             Report/Follow-up Police Investigation Report

 Processing of Pension Loan availed                         3
                                                                                       Underwriting Department)          Affidavit of witnesses to the incident
 thru the GSIS eCard                                                                                                     Certified copy of Time Card/Record of
                                                                                                                          Attendance, when applicable
 Processing of Survivorship Benefits                        60
                                          (upon receipt of complete documents)                                           Mission Order/Travel Order/Trip Ticket,
                                                                                                                          when applicable
 Processing of Funeral Benefits                             60                                                           Line of Duty Board Proceedings (for
                                          (upon receipt of complete documents)
                                                                                                                          uniformed personnel of the AFP)
 Respond to pensioners’ complaints,       Within 10 working days from receipt of                                         Napolcom Adjudication Award (for PNP)
 requests or queries                      the complaint, request or query by the                                         Certified copy of Declaration of Presumptive
                                                   GSIS Operating Unit
                                                                                                                          Death, when applicable
                                           (Note: Requests for reconciliation of                                         Original/certified copy of Death Certificate
                                              pensioner accounts (i.e. pension                                            of employee from NSO
                                            payments and pension loan, among                                             If employee is single, original/certified copy
                                             others. are not included in the 10-                                          of Death Certificate of parents from NSO, if
                                               working days processing time)                                              deceased,
For Partner Agencies and Other External Agencies:                                                                        Original/certified copy of Marriage Contract
                                                                                                                          of employee/parents (as the case may be)
 Creation of Agency Record                            Within the day                                                      from NSO
 Updating of Agency Record                            Within the day                                                     Original/certified copy of Birth Certificate of
                                                                                                                          employee (if single)/surviving spouse/minor
 Receipt of Payment (over-the-                        Within the day
                                                                                                                          children from NSO (in case not yet
 counter) through the GSIS Cash
                                                                                                                          registered, late NSO registration can be
 Receipting Facility
                                                                                                                          filed)
 Processing of Claims (for General                          30                                                           Proofs of Surviving Legal Heirs
 Insurance Product lines)                  (upon receipt of complete documents                                           If employee is single, Affidavit of parents
                                             including final adjuster’s report)
                                                                                                                          that employee died single, without child/
Response to partner and external          Within 10 working days from receipt of                                          children and they are wholly dependent
agencies’ requests for data or report     the complaint, request or query by the                                          upon the employee for support
                                                   GSIS Operating Unit

                                           (Note: Requests for reconciliation of       IX. PRE-NEED                      OEM/TERMINATION OF PRE-NEED PLAN
                                          agency accounts are not included in the                                         (EDU-CHILD, MEMORIAL)
                                            10-working days processing time)                                               GSIS Pre-need application form
                                                                                                                              GSIS Release & Quit claim form
                                                                                                                               (Optional Exit Mechanism)
                                                                                                                              Original copy of Certificate of Full
                                                                                                                               payment
                                                                                                                              Original copy of Plan Agreement (in
                                                                                                                               case of loss, execute Affidavit of Loss)
                                                                                                                              Original & Xerox copy of Certificate of
                                                                                                                               Premium payments
   GSIS Citizen’s Charter 2011                                                      24           GSIS Citizen’s Charter 2011                                                5


      TRANSACTION                       DOCUMENTARY REQUIREMENTS                                                        DOCUMENTARY REQUIREMENTS

                              X. Death due to Vehicular Accident                                      TRANSACTION                     DOCUMENTARY REQUIREMENTS
VIII. EC Claims
       Under PD 626                Income Benefit Claim for Payment Parts I &                I. Retirement Benefit              RETIREMENT BENEFIT under RA 8291, RA
                                      II                                                         Claim                            660, 1146
(Note: All EC Claims should        Hospitalization Claim for Payment Parts I, II                                                  Latest GSIS Retirement Application
have medical report from              & III                                                                                           form duly endorsed and signed by the
Medical Evaluation and
Underwriting Department)
                                   Original/certified copy of Service Record /                                                       authorized officials
                                      Statement of Service                                                                         Latest 1x1 ID picture within the last 3
                                   Certification (notarized) by Head of Office/                                                      months. - Application form signed
                                      Commanding Officer narrating in detail the                                                      by the retiree with the following
                                      circumstances of the accident: time, place,                                                     entries:
                                      date and reasons or purpose for being at the                                                     Name
                                      place of accident                                                                                Date of Retirement
                                   Certified copy of Police Traffic Accident                                                          Date of Application
                                      Report
                                   Certified copy of Medical records of                                                               Mode/Option of Retirement
                                      confinement/treatment                                                                            Office
                                   Admitting History or Medical Abstract                                                              Signature
                                   Certified copy of Time Card/Record of                                                              Mailing Address
                                      Attendance, when applicable                                                                      Contact Number
                                   Mission Order/Travel Order/Trip Ticket,                                                            Date of Birth
                                      when     applicable                                                                              Certificate of Last Day of Actual
                                   Vicinity sketch showing the location, the                                                              Service (LDAS)
                                      route taken and the distance in meters/                                                    REFUND OF RETIREMENT PREMIUMS
                                      kilometers     between the place of accident,                                               A. RA 1616
                                      place of work and residence (if employee is                                                      Original copy of Retirement of
                                      going to or coming from work)                                                                        Gratuity benefit approved and
                                   Original/certified copy of Death Certificate                                                           paid by the last employer for RA
                                      of employee from NSO                                                                                 1616
                                   If employee is single, original/certified copy                                                     Photocopy of GSIS Retirement
                                      of Death Certificate of parents from NSO, if                                                         Application Form Authenticated
                                      deceased                                                                                             by the agency
                                   Original/certified copy of Marriage Contract                                                       Retirement computation under
                                      of employee/parents (as the case may be)                                                             RA 1616 indorsed by the head of
                                      from NSO                                                                                             office or authorized signatory
                                   Original/certified copy of Birth Certificate of                                               B. In case Portability Law RA 7699 is
                                      employee (if single)/surviving spouse/minor                                                    applied, Certification of SSS premium
                                      children from NSO (in case not yet                                                             contributions signed by authorized SSS
                                      registered, late NSO registration can be                                                       Officer is needed.
                                      filed)
                                   Proofs of Surviving Legal Heirs                           II. Disability Benefits            PERMANENT TOTAL DISABILITY
                                   If employee is single, Affidavit of parents
                                                                                                  Claim                               Disability Retirement Form (Parts I & II)
                                                                                                                                       duly endorsed and signed by the Authorized
                                      that    employee died single, without child/                                                     Officials
                                      children and they are wholly dependent                                                          Latest 1 x 1 ID picture (within the last 3
                                      upon the employee for support                                                                    months)
                              XI. Death due to Injury caused by gunshot                                                               Medical examination report from the Medical
                                  wounds                                                                                               Evaluation and Underwriting Department
                                                                                                                                       (MEUD)
                                    Income Benefit Claim for Payment parts I &
                                      II                                                                                         PERMANENT     PARTIAL               DISABILITY/
                                                                                                                                  TEMPORARY DISABILITY
                                     Hospitalization Claim for Payment parts I, II & III
                                                                                                                                      Income      Benefit   Claim    for   Payment
                                     Original/certified copy of Service Record                                                        (Parts I, II)
                                     Certification (notarized) by Head        of   Office/                                           Hospitalization     Claim     for    Payment
                                      Commanding Officer narrating in                                                                  (Parts I, II)
   GSIS Citizen’s Charter 2011                                           6            GSIS Citizen’s Charter 2011                                                23


        TRANSACTION                DOCUMENTARY REQUIREMENTS                               TRANSACTION                      DOCUMENTARY REQUIREMENTS

II. Disability Benefits          Certification from the employer stating          VIII. EC Claims               VIII. Disability due to Injury caused by
    Claim                                                                                 Under PD 626                  Other Accidents
                                  that the reduction in income was due to
                                                                                                                       Income Benefit Claim for Payment parts I
                                  the impairment/disability                        (Note: All EC Claims should            and II
                                 Operating Room Record/Histopath Report           have medical report from            Hospitalization Claim for Payment parts I,
                                                                                   Medical Evaluation and                 II and III
                                 Certification of the Employer for Sick           Underwriting Department)
                                  Leave Without Pay (LWOP), if there’s any                                             Original/authenticated copy of Service Re-
                                                                                                                          cord/Statement of Service
                                 Medical examination report from Medical                                              Certification (notarized) by Head of
                                  Evaluation and Underwriting Department                                                  Office/Commanding Officer narrating in
                                  (MEUD)                                                                                  detail the      circumstances of the
                                                                                                                          accident: time, place, date and reasons or
                                                                                                                          purpose for being at the place of
                                                                                                                          accident
III. Survivorship            Basic Documents:                                                                         Certified copy of Police Investigation Re-
      Benefits Claims            Application for Survivorship Benefit                                                    port/Follow-up Investigation Report
                                 Death Certificate of member/pensioner
                                                                                                                       Original copy of Affidavit of witnesses to
                                                                                                                          the incident
                                  issued by NSO
                                                                                                                       Certified copy of Mission Order/Travel Or-
                                 Marriage Certificate between the deceased                                               der/Trip Ticket, when applicable
                                  and his/her spouse issued by NSO                                                     Certified copy of Time Card/Record of At-
                                 Birth Certificate of surviving spouse/                                                  tendance
                                  dependent children/incapacitated child/                                              Certified copy of Medical records of
                                  surviving parent/guardian, as the case                                                  confinement/treatment
                                  may be, issued by NSO (in case not yet
                                                                                                                 IX. Killed in Action (for uniformed personnel of the
                                  registered, late NSO registration can be                                           AFP & PNP)
                                  filed)
                                                                                                                        Income Benefit Claim for Payment parts I and II
                                 Affidavit of Guardianship of Incapacitated                                            Original/authenticated copy of Statement       of
                                  Dependent Child                                                                        Service
                                 Affidavit   of   Guardianship      of    Minor                                        Authenticated copy of Casualty Report
                                  Dependent Child                                                                       Authenticated copy of Army Operations Center
                                 Affidavit of Surviving Spouse if with minor                                            (AOC) Journal (for PA only)
                                  children, supported by certification from                                             Spot Report/After Battle Report
                                                                                                                         authenticated
                                  Department      of    Social   Welfare     and
                                  Development (DSWD)/Barangay where the
                                                                                                                        Original/certified copy of Death
                                                                                                                         Certificate of employee from NSO
                                  minor resides
                                                                                                                        If employee is single, original/certified copy of
                                 Two valid IDs (original and photocopy) of                                              Death     Certificate of parents from NSO, if
                                  surviving     spouse/dependent       children/                                         deceased,
                                  incapacitated      child/surviving    parent/                                         Original/certified copy of Marriage
                                  guardian, as the case may be (e.g., GSIS                                               Contract of employee/parents (as the case may
                                                                                                                         be) from NSO
                                  eCard, SSS ID, Driver’s license, Passport,)
                                                                                                                        Original / certified copy of Birth Certificate of
                                                                                                                         employee (if single) / surviving spouse/minor
                             If with adopted minor and/or physically/                                                   children from NSO (in case not yet registered,
                              mentally incapacitated children                                                            late NSO registration can be filed)
                               Adoption papers issued by the court                                                     Proofs of Surviving Legal Heirs

                                 Affidavit of Guardianship of Incapacitated
                                                                                                                        If employee is single, Affidavit of parents that
                                                                                                                         employee died single, without child/children and
                                  Dependent Child                                                                        they are wholly dependent upon the
                                 Affidavit   of  Guardianship    of  Minor                                              employee for support spouse/minor children from
                                                                                                                         NSO (in case not yet registered, late NSO)
                                  Dependent Child
   GSIS Citizen’s Charter 2011                                                  22          GSIS Citizen’s Charter 2011                                         7


     TRANSACTION                         DOCUMENTARY REQUIREMENTS                              TRANSACTION                  DOCUMENTARY REQUIREMENTS

VIII. EC Claims                              Proofs of Surviving Legal Heirs            III. Survivorship              In the absence of the Court Order, the
       Under PD 626                                                                           Benefits Claims            affidavit, as applicable in each case, shall be
                                             If employee is single, Affidavit of
                                              parents that employee died single,                                         supported by a Certification of Guardianship
(Note: All EC Claims should                                                                                              from the Barangay Captain and the City/
have medical report from                      without child/children and they are
Medical Evaluation and                        wholly dependent upon the employee                                         Municipal Social Welfare Head where the
Underwriting Department)                      for support                                                                incapacitated/dependent child is residing
                                                                                                                        In case of incapacitated dependent child who
                              VI. Wounded in Action (for uniformed personnel of                                          is over the age of majority, medical
                                  AFP)                                                                                   (historical) records showing that the
                                      Income Benefit Claim for Payment parts I and                                      dependent child is incapable of self-support
                                       II                                                                                due to mental or physical defect acquired
                                      Hospitalization Claim for Payment parts I, II                                     prior to the age of majority
                                       and III                                                                     If member died single
                                      Original/authenticated copy of Statement of                                      Birth Certificate of deceased member
                                       Service
                                                                                                                        Marriage Contract and Birth Certificates of
                                      Authenticated copy of Army Operations                                             parents issued by NSO (in case not yet
                                       Center (AOC) Journal (for PA only)                                                registered, late NSO registration can be filed)
                                      Authenticated copy of Spot Report/After Bat-                                     Affidavit of surviving parents stating under
                                       tle Report                                                                        oath that the deceased member/pensioner at
                              VII. Disability due to Vehicular Accident                                                  the time of death was not survived by a
                                                                                                                         spouse or dependent children; and that the
                                      Income Benefit Claim for Payment parts I &                                        parents are dependent for support from the
                                       II                                                                                said deceased member/pensioner
                                      Hospitalization Claim for Payment parts I, II                                    Death Certificate of deceased parent issued
                                       and III                                                                           by NSO, if only one surviving parent
                                      Original/certified copy of Service Record/                                  If both parents are deceased
                                       Statement of Service
                                                                                                                        Birth Certificate of deceased member
                                      Certification (notarized) by Head of Office/
                                                                                                                        Marriage Contract of Parents of the deceased
                                       Commanding Officer narrating in detail the                                        member
                                       circumstances of the accident: time, place,
                                                                                                                        Death Certificate of parents
                                       date and reasons or purpose for being at the
                                       place of accident
                                                                                                                        Birth Certificate of surviving siblings issued
                                                                                                                         by NSO (in case not yet registered, late NSO
                                      Certified copy of Police Investigation Report                                     registration can be filed)
                                      Original copy of Affidavit of witnesses to the                                   Marriage Contract of married female sister/s
                                       incident                                                                          issued by NSO
                                      Certified copy of Mission Order/Travel                                           Affidavit of surviving brother/sister of the
                                       Order/Trip Ticket, when applicable                                                deceased member/pensioner stating under
                                                                                                                         oath that the deceased member/pensioner at
                                      Certified copy of Time Card/Record of
                                                                                                                         the time of death was not survived by a
                                       Attendance                                                                        spouse or dependent children and parents
                                      Vicinity sketch showing the location, the                                         and that they are the only surviving legal
                                       route taken and the distance in meters/                                           heirs
                                       kilometers between the place of accident,
                                                                                        IV. Death Claim             A.   Life Endowment Policy (LEP) - payable to the
                                       place of work and residence
                                                                                                                         designated beneficiaries
                                      Certified copy of Medical records of
                                                                                                                         (Subject to the provisions of Insurance Law
                                       confinement/treatment
                                                                                                                         on questionable death)
    GSIS Citizen’s Charter 2011                                         8             GSIS Citizen’s Charter 2011                                           21


    TRANSACTION                 DOCUMENTARY REQUIREMENTS                                 TRANSACTION                    DOCUMENTARY REQUIREMENTS
IV. Death Claim        If the spouse is the designated beneficiary               VIII. EC Claims                           If employee is single, original/
                            Original copy of NSO certified Death Certificate            Under PD 626                        certified copy of Death Certificate of
                             of member                                                                                       parents from NSO, if deceased
                         Original copy of NSO certified Marriage Contract
                                                                                  (Note: All EC Claims should               Original/certified copy of Marriage
                                                                                  have medical report from                   Contract of employee/parents (as
                             (in case not yet registered, late NSO                Medical Evaluation and                     the case may be) from NSO
                             registration can be filed)                           Underwriting Department)
                                                                                                                            Original/certified copy of Birth
                         Two valid IDs of spouse (original to be shown,                                                     Certificate of employee (if single)/
                             photocopy to be submitted)                                                                      surviving    spouse/minor      children
                                                                                                                             from NSO (in case not yet
                         Birth Certificate of the Spouse (in case not yet                                                   registered, late NSO registration can
                             registered, late NSO registration can be filed)                                                 be filed)
                       If the children are the designated beneficiaries                                                    Proofs of Surviving Legal Heirs
                           Original copy of NSO certified Death Certificate                                                If employee is single, Affidavit of
                            of member                                                                                        parents that employee died single,
                                                                                                                             without child/children and they are
                           Original copy of NSO certified Birth Certificate of                                              wholly dependent upon the
                            the children (in case not yet registered, late NSO                                               employee for support
                            registration can be filed)
                            Original copy of NSO certified Marriage Contract                                      Death due to Bronchial Asthma
                             of married designated female children                                                       Income Benefit Claim for Payment
                                                                                                                            parts I and II
                         Affidavit of Guardianship of Minor Dependent
                                                                                                                         Hospitalization Claim for Payment
                             Child                                                                                          parts I, II and III
                         Two valid IDs (original to be shown, photocopy                                                 Original/certified copy of Service
                             to be submitted)                                                                               Record/Statement of Service
                       If the parents are the designated beneficiaries                                                  Certified copy of medical records of
                            Original copy of NSO certified Death Certificate                                               consultation/confinement      due    to
                                                                                                                            Bronchial Asthma
                             of member
                                                                                                                         Chest x-ray film (latest)
                         Original copy of NSO certified Birth Certificate of                                            Certified copy of result of
                             the deceased member (in case not yet                                                           Sensitivity Test to allergens in the
                             registered, late NSO registration can be filed)                                                workplace
                         Original copy of NSO certified Marriage                                                        Proofs that occupation involves in-
                             Contract of parents, if necessary (subject to law                                              creased risk of contracting
                             on donation)                                                                                   Bronchial Asthma
                                                                                                                         Original copy of Statement of
                         If one parent is deceased , Original copy of NSO                                                  Accounts and itemized list and cost
                             certified Death Certificate of deceased parent                                                 of all charges during confinement
                         Two valid IDs of parents (original to be shown,                                                Original official receipts of hospital
                             photocopy to be submitted)                                                                     bills/doctor’s fees, medicines
                                                                                                                            purchased
                         Original copy of NSO Birth Certificates of
                             parents, in the absence thereof, valid passport
                                                                                                                         Original/certified copy of Death
                                                                                                                            Certificate of employee from NSO
                             or visa, driver’s license, PRC IDs
                                                                                                                         If employee is single, original/
                       If there is no designated beneficiary - died     single                                             certified copy of Death Certificate of
                           Original copy of NSO certified Death Certificate                                                parents from NSO, if deceased
                            of member                                                                                    Original/certified copy of Marriage
                                                                                                                            Contract of employee/parents (as
                           Birth Certificate of Legitimate/illegitimate
                                                                                                                            the case may be) from NSO
                            child/ren (in case not yet registered, late NSO                                                 Original / certified copy of Birth
                            registration can be filed)                                                                      Certificate of employee (if single)/
                                                                                                                            surviving registration can be filed)
   GSIS Citizen’s Charter 2011                                        20             GSIS Citizen’s Charter 2011                                      9


       TRANSACTION                   DOCUMENTARY REQUIREMENTS                          TRANSACTION                 DOCUMENTARY REQUIREMENTS

VIII. EC Claims                          Original copy of Statement of            IV. Death Claim          Proofs of Surviving Legal Heirs and
       Under PD 626                       Accounts and itemized list and cost of                             Guardianship (child/ren)
                                          all charges during confinement
(Note: All EC Claims should                                                                             If there is/are no legitimate/illegitimate child/ren,
have medical report from                 Original official receipts of hospital
Medical Evaluation and                    bills/doctor’s fees, medicines                                 Death      benefits    shall    be     payable     to
Underwriting Department)                  purchased                                                      surviving parents, in which case, the following docu-
                                         Original/certified copy of Death                               ments shall be required:
                                          Certificate of employee from NSO                                  Original copy of NSO certified Death Certificate
                                         If employee is single, original/                                   of member
                                          certified copy of Death Certificate of
                                          parents from NSO, if deceased
                                                                                                            Original copy of NSO certified Birth Certificate of
                                                                                                             member
                                         Original/certified copy of Marriage
                                          Contract of employee/parents (as the                              Original copy of NSO Marriage Contract of
                                          case may be) from NSO                                              parents
                                         Original/certified copy of Birth                                  Affidavit of Surviving   Legal Heirs (Parent/s)
                                          Certificate of employee (if single)/                               stating among others that the deceased member
                                          surviving spouse/minor children from
                                                                                                             was not survived by a spouse and children
                                          NSO (in case not yet registered, late
                                          NSO registration can be filed)                                    Two valid IDs of parents (original to be shown,
                                         Proofs of Surviving Legal Heirs                                    photocopy to be submitted)
                                         If employee is single, Affidavit of                               Original copy of NSO issued Death Certificate of
                                          parents that employee died single,                                 deceased parent, if only one parent survived
                                          without child/children and they are
                                                                                                            Original copy of NSO Birth Certificates of
                                          wholly dependent upon the employee
                                          for support                                                        parents, in the absence thereof, valid passport
                                 Death due to Pneumonia                                                     or visa, driver’s license, PRC IDs
                                         Income Benefit Claim for Payment
                                                                                                        If both parents are deceased, Death benefits shall be
                                          parts I and II
                                                                                                         payable to the surviving siblings in which case the
                                         Hospitalization Claim for Payment
                                                                                                         following must be submitted:
                                          parts I, II and III
                                         Original/certified copy of Service                                Original copy of NSO certified Death Certificate
                                          Record/Statement of Service                                        of member
                                         Certified copy of hospital/clinical                               Original copy of NSO certified Birth Certificate of
                                          records due to Pneumonia                                           member
                                         Chest x-ray film (latest)                                         Original copy of NSO certified Death Certificate
                                         Proofs that occupation involves                                    of parents
                                          increased risk of contracting
                                                                                                            Original copy of NSO certified Birth Certificate of
                                          Pneumonia
                                                                                                             all brothers & sisters (in case not yet registered,
                                         Statement of Actual Duties
                                                                                                             late NSO registration can be filed)
                                         Original copy of Statement of
                                          Accounts and itemized list and cost of                            Original copy of NSO certified Marriage Contract
                                          all charges during confinement                                     of all married sisters
                                         Original official receipts of hospital                            Original copy of NSO certified Death Certificate
                                          bills/doctor’s fees, medicines                                     of deceased brothers & sisters
                                          purchased
                                                                                                            Affidavit of surviving Legal Heirs stating among
                                         Original/certified copy of Death
                                                                                                             others that they are the only surviving legal
                                          Certificate of employee from NSO
                                                                                                             heirs of the deceased member
     GSIS Citizen’s Charter 2011                                       10            GSIS Citizen’s Charter 2011                                            19


      TRANSACTION                  DOCUMENTARY REQUIREMENTS                              TRANSACTION                    DOCUMENTARY REQUIREMENTS

IV. Death Claim                                                                   VIII. EC Claims                     If employee is single, Affidavit of parents
                              Two valid IDs of legal heirs whom death claim
                                                                                         Under PD 626                   that employee died single, without child/
                               benefit shall be made payable (original to be
                               shown, photocopy to be submitted)                                                        children and they are wholly dependent
                                                                                  (Note: All EC Claims should           upon the employee for support
                              Copy of NSO Certified Marriage Contract of         have medical report from
                               Parents                                            Medical Evaluation and           Death due to CVA
                                                                                  Underwriting Department)
                                                                                                                      Income Benefit Claim for payment parts
                         If there is no designated beneficiary - married                                               I, II and III
                              Original copy of NSO Marriage Contract of the                                          Original/certified copy of Service Record/
                               deceased                                                                                 Statement of Service
                              Original copy of NSO Birth Certificate of all                                          Certified copy of previous medical
                               children and spouse (in case not yet                                                     records of consultation/confinement and
                               registered, late NSO registration can be filed)                                          laboratory results for the treatment of
                              Affidavit of surviving Legal Heirs (please use                                           Hypertension
                               prescribed form) stating among others that                                             Original copy of Statement of Accounts
                               they are the only surviving legal heirs of the                                           and itemized list and cost of all charges
                               deceased                                                                                 during confinement
                              Two valid IDs of legal heirs (original to be                                           Original official receipts of hospital bills/
                               shown, photocopy to be submitted)                                                        doctor’s fees, medicines purchased
                                                                                                                      Original/certified     copy     of    Death
                         If  there    is   no    designated    beneficiary   -                                         Certificate of employee from NSO
                          widowed
                                                                                                                      If employee is single, original/certified
                           Original copy of NSO certified Death Certificate                                            copy of Death       Certificate of parents
                              of member                                                                                 from NSO, if deceased
                           Original copy of NSO certified Marriage                                                   Original/certified copy of Marriage
                              Contract of the deceased                                                                  Contract of employee/parents (as the
                           Original copy of NSO certified Birth Certificate                                            case may be) from NSO
                              of all children (in case not yet registered, late                                       Original/certified copy of Birth Certificate
                              NSO registration can be filed)                                                            of employee (if single)/surviving spouse/
                           Proofs of Surviving Legal Heirs and                                                         minor children from NSO (in case not yet
                              Guardianship (please use prescribed form)                                              registered, late NSO registration can be
                              stating among others that they are the only                                               filed)
                              surviving legal heirs of the deceased                                                   Proofs of Surviving Legal Heirs
                           Two valid IDs of legal heirs (original to be                                              If employee is single, Affidavit of parents
                              shown, photocopy to be submitted)                                                         that employee died single, without child/
                           If there are no child/ren, claim shall be                                                   children and they are wholly dependent
                              payable to surviving parents. If parents are                                              upon the employee for support
                              already deceased, claim shall be payable to
                              siblings (Refer to requirements for members                                          Death due to PTB
                              who died single)                                                                        Income Benefit Claim for Payment parts
                                                                                                                        I and II
                          B. Enhanced Life Policy - Payable to Surviving                                              Hospitalization Claim for Payment parts
                             Legal Heirs (Subject to the provisions of                                                  I, II and III
                              nsurance Law on questionable death)
                                                                                                                      Original/certified copy of Service Record/
                              Died Single
                                                                                                                        Statement of Service
                                   Original copy of NSO certified Death                                              Certified copy of Hospital/clinical records
                                    Certificate of member                                                               due to PTB
                                                                                                                      Chest x-ray film (latest)
     GSIS Citizen’s Charter 2011                                            18              GSIS Citizen’s Charter 2011                                      11


      TRANSACTION                     DOCUMENTARY REQUIREMENTS                              TRANSACTION                DOCUMENTARY REQUIREMENTS

VIII. EC Claims                    Original/certified copy of Marriage Contract        IV. Death Claim          Birth Certificate of Legitimate/illegitimate
       Under PD 626                   of employee/parents (as the case may be)                                    child/ren (in case not yet registered, late NSO
                                      from NSO                                                                    registration can be filed), if any
(Note: All EC Claims should
have medical report from             Original/certified copy of Birth Certificate of
                                                                                                                 Affidavit of Surviving Legal Heirs (child/ren)
Medical Evaluation and                employee (if single)/surviving spouse/minor
                                                                                                                  stating among others that they are the only
Underwriting Department)              children from NSO (in case not yet
                                      registered, late NSO registration can be                                    surviving legal heirs of the deceased
                                      filed)                                                                     NSO Certified Marriage Certificate of married
                                     Proofs of Surviving Legal Heirs                                             female children, if any
                                   If employee is single, Affidavit of parents
                                      that employee died single, without child/                              If there is/are no legitimate/illegitimate child/ren,
                                      children and they are wholly dependent                                  Death benefits shall be payable to surviving
                                      upon the employee for support                                           parents, in which case, the following documents shall
                                                                                                              be required:
                                  Death due to hypertension/HCVD/HASCVD/                                        Original copy of NSO certified Death Certificate of
                                   CAD/M.I/Other Ailments
                                                                                                                  member
                                   Income Benefit Claim for Payment parts I
                                     and II
                                                                                                                 Original copy of NSO certified Birth Certificate of
                                                                                                                  member
                                   Hospitalization Claim for Payment parts I, II
                                     and III                                                                     Original copy of NSO Marriage Contract of parents
                                   Original/certified copy of Service Record/                                   Affidavit of Surviving   Legal Heirs (parent/s)
                                     Statement of Service                                                         stating among others that the deceased member
                                   Certified copy of previous medical records of                                 was not survived by a spouse and children
                                     consultation/confinement and laboratory                                     Original copy of NSO certified Birth Certificates of
                                     results for the treatment of Hypertension                                    parents (in case not yet registered, late NSO
                                   ECG tracings, 2D Echo, if done                                                registration can be filed), or in its absence, valid
                                   Original copy of Statement of                                                 passport or visa, driver’s license, PRC IDs
                                      Accounts and itemized list and cost of all                                 Two valid IDs of parents (Original to be shown,
                                      charges during confinement                                                  photocopy to be submitted)
                                     Original official receipts of hospital bills/
                                                                                                                 Original copy of NSO issued Death Certificate of
                                      doctor’s fees and medicines purchased
                                                                                                                  deceased parent, if only one parent survived
                                     Original/certified copy of Death Certificate
                                      of employee from NSO
                                                                                                             If both parents are deceased, Death benefits shall be
                                     If employee is single, original/certified copy
                                                                                                              payable to the surviving siblings in which case the
                                      of Death Certificate of parents from NSO, if
                                                                                                              following must be submitted:
                                      deceased
                                     Original/certified copy of Marriage Contract                               Original copy of NSO certified Death Certificate of
                                      of employee/parents (as the case may be)                                    member
                                      from NSO                                                                   Original copy of NSO certified Birth Certificate of
                                     Original/certified copy of Birth Certificate of                             member
                                      employee (if single) / surviving spouse/                                   Original copy of NSO certified Death Certificate of
                                      minor children from NSO (in case not yet                                    parents
                                      registered, late NSO registration can be                                   Original copy of NSO certified Birth Certificate of
                                      filed)                                                                      all brothers & sisters (in case not yet registered,
                                     Proofs of Surviving Legal Heirs (notarized)                                 late NSO registration can be filed)
                                      signed by claimant and two (2) disinterested                               Original copy of NSO certified Marriage Contract
                                      persons                                                                     of all married sisters
    GSIS Citizen’s Charter 2011                                       12              GSIS Citizen’s Charter 2011                                                17


    TRANSACTION                   DOCUMENTARY REQUIREMENTS                                TRANSACTION                       DOCUMENTARY REQUIREMENTS
IV. Death Claim            Original copy of NSO certified Death Certificate of    VIII. EC Claims               III. Hospitalization Benefit - expenses paid by
                            deceased brothers & sisters                                   Under PD 626                 HMO
                           Affidavit of surviving Legal Heirs stating among                                           Hospitalization Claim for Payment (Parts I, II
                                                                                   (Note: All EC Claims should           and III)
                            others that they are the only surviving legal heirs    have medical report from
                            of the deceased member                                 Medical Evaluation and              Certification from Head of Office/Health
                           Two valid IDs of legal heirs whom death claim          Underwriting Department)              Insurance Company that employee is a policy
                                                                                                                         holder of health insurance and he/she is
                            benefit shall be made payable (original to be
                                                                                                                         personally paying the premiums either thru
                            shown, photocopy to be submitted)
                                                                                                                         cash or salary deduction.
                       Died Married                                                                                   Proof of payment of health insurance
                           Original copy of NSO Certified Death Certificate of                                          premiums (pay slip/original official receipts)
                            member                                                                                     Certification from Insurance Company that
                           Original copy of NSO Marriage Contract of the                                                they have fully paid the hospital bills in the
                                                                                                                         amount of _____ under O.R. No. _____ dated
                            deceased
                                                                                                                         _____ and the original copies of         hospital
                           Original copy of NSO Birth Certificate of all                                                bills and other documents were filed with
                            children and spouse (in case not yet registered,                                             them.
                            late NSO registration can be filed)                                                        Certified copy of Statement of Accounts and
                           Affidavit of Surviving Legal Heirs (please use                                               itemized list and cost of all charges during
                            prescribed form) stating among others that they                                              confinement
                            are the only surviving legal heirs of the deceased                                         Certified copy of official receipts of hospital
                           Two valid IDs of all Surviving Legal Heirs (original                                         bills & doctor’s fees
                            to be shown, photocopy to be submitted)                                              IV. Medical Benefit (with previously approved
                                                                                                                      claim)
                           NSO Certified Marriage Certificate of Married
                                                                                                                       Original official receipts of medicines
                            Female Children                                                                                 purchased, consultation fees and other
                                                                                                                            medical expenses.
                       Died Widowed
                                                                                                                       Medical Certificate
                           Original copy of NSO Certified Death Certificate of                                        Doctor’s prescriptions
                            member                                                                               V. Death due to Sickness
                           Original copy of NSO certified Marriage Contract                                           Income Benefit Claim for Payment parts I
                            of the deceased                                                                                 and II
                           Original copy of NSO certified Death Certificate of                                        Hospitalization Claim for Payment parts I, II
                            spouse                                                                                          and III
                           Original copy of NSO Birth Certificate of all                                              Original/certified copy of Service Record/
                            children (in case not yet registered, late NSO                                                  Statement of Service
                            registration can be filed)                                                                 Certified copy of all medical records of
                           Affidavit of All Surviving Legal Heirs (please use                                              consultation/confinement which caused the
                            prescribed form) stating among others that they                                                 death of the employee
                            are the only surviving legal heirs of the deceased                                         Original copy of Statement of Accounts and
                           Two valid IDs of all Surviving Legal Heirs (original                                            itemized list and cost of all charges during
                            to be shown, photocopy to be submitted)                                                         confinement
                           If there are no child/ren, claim shall be payable to                                       Original official receipts of hospital bills/
                                                                                                                            doctor’s fees, medicines purchased
                            surviving parents. If parents are already
                            deceased, claim shall be payable to siblings (Refer                                        Original/certified copy of Death Certificate
                            to requirements for members who died single)                                                    of employee from NSO
                           NSO Certified Marriage Certificate of Married                                              If employee is single, original/certified copy
                            Female Children                                                                                 of Death Certificate of parents from NSO,
                                                                                                                            if deceased
     GSIS Citizen’s Charter 2011                                                16              GSIS Citizen’s Charter 2011                                              13


     TRANSACTION                          DOCUMENTARY REQUIREMENTS
                                                                                                  TRANSACTION                    DOCUMENTARY REQUIREMENTS
VIII. EC Claims                         Proofs that occupation involves increased
       Under PD 626                                                                        V. Cash Surrender            Application for Retirement and Other Social
                                         risk of contracting Pneumonia
                                                                                              Value
                                        Statement of Actual Duties                                                      Insurance Benefits duly signed by member and
(Note: All EC Claims should
                                                                                                                         endorsed by authorized approving officer of
have medical report from
Medical Evaluation and
                                    BRONCHIAL ASTHMA                                                                    Agency
Underwriting Department)                Income Benefit Claim for Payment parts I                                       Certification of Last Day of Service
                                         and II
                                                                                                                        In the event of death prior to payment of benefit,
                                        Hospitalization Claim for Payment parts I, II
                                         and III                                                                         claim shall be payable to surviving legal heirs.
                                                                                                                         Documentary requirements for LEP policy shall
                                        Original/certified copy of Service Record/
                                         Statement of Service                                                            apply
                                        Certified copy of approved leave application
                                                                                           VI. Maturity Claim           Application for Retirement and Other Social
                                        Certified copy of medical records of
                                         consultation/confinement due to Bronchial                                       Insurance Benefits duly signed by member
                                         Asthma                                                                         In the event of death after maturity and prior to
                                        Chest x-ray film (latest)                                                       payment of the benefit, claim shall be payable to
                                        Certified copy of result of Sensitivity Test to                                 surviving legal heirs. Documentary requirements
                                         allergens in the workplace                                                      for LEP policy shall apply.
                                        Proofs that occupation involves increased
                                         risk of contracting Bronchial Asthma              VII. Funeral Benefits        If claimant is the legal spouse

                                    OSTEOARTHRITIS            (for        Uniformed                                         Original copy of Death Certificate of the member
                                     Personnel of the AFP)                                                                    from NSO
                                      Income Benefit Claim for Payment parts I                                              Original copy of Marriage Contract from NSO
                                         and II                                                                              Two valid ID (original to be shown,
                                      Hospitalization Claim for Payment parts I, II                                          photocopy to be submitted)
                                         and III                                                                             Original copy of NSO certified Birth
                                      Authenticated copy of Statement of Service                                             Certificate of the claimant (if there will be claims
                                         indicating date of Complete Disability                                               for death and survivorship benefits). If not regis-
                                                                                                                              tered, may apply for late
                                         Discharge (CDD)
                                                                                                                              registration.
                                      Certified copy of hospital/clinical records
                                                                                                                             For immediate full payment of the benefits, and in
                                         during confinement
                                                                                                                              the absence of NSO Birth Certificate, -valid pass-
                                      X-ray film of the affected area prior to CDD                                           port or visa; driver’s license; PRC ID with record of
                                        Authenticated copy of CDD papers                                                     birth may be presented.

                              II.   Hospitalization Benefit (with previous                                              If Claimant is other than the legal spouse
                                     approved claims)                                                                        GSIS Affidavit of Funeral Expense Form
                                      Hospitalization Claim for Payment parts I, II                                         Original copy of Death Certificate of the member
                                          and III                                                                             from NSO
                                      Statement of Accounts (original copy only)                                            Original & Xerox copy of Official Receipt
                                                                                                                              under the claimant’s name.
                                        Itemized list and cost of all charges during
                                         confinement (original)
                                                                                                                             Two valid ID’s (original to be shown,
                                                                                                                              photocopy to be submitted)
                                        Official receipts of hospital bills & doctor’s                                       Birth Certificate of the Claimant or valid ID issued
                                         fees (original)                                                                      by the government, indicating his/her date of birth

                                        Official receipts of medicines purchased                                      Note: If a Funeral Plan was used, the same can be used in
                                         (original)                                                                    lieu of the Official Receipts. However, the benefits shall be
                                                                                                                       paid in accordance with the order of priorities as provided
                                        Admitting History or Medical Abstract                                         under R.A. 8291.
    GSIS Citizen’s Charter 2011                                                14          GSIS Citizen’s Charter 2011                                        15


      TRANSACTION                        DOCUMENTARY REQUIREMENTS                               TRANSACTION                    DOCUMENTARY REQUIREMENTS

VIII. EC Claims               I. Sickness:                                               VIII. EC Claims                  CVA
       Under PD 626                 Income Benefit Claim for Payment (Parts I                  Under PD 626                Income Benefit Claim for Payment parts I
                                       and II) signed by employee/claimant and                                               and II
(Note: All EC Claims should                                                              (Note: All EC Claims should        Hospitalization Claim for Payment parts I,
                                       employer indicating logbook entry number
have medical report from                                                                 have medical report from            II and III
Medical Evaluation and
                                       and date of contingency.                          Medical Evaluation and
Underwriting Department)            Hospitalization Claim for Payment (Parts I,         Underwriting Department)           Original/certified copy of Service Record/
                                                                                                                             Statement of Service
                                       II and III) signed by Hospital Official,
                                       Attending Physician/Surgeon and                                                      Certified copy of approved leave
                                                                                                                             application
                                       Anesthesiologist.
                                                                                                                            Certified copy of previous and latest
                                    Original/certified copy of updated Service                                              medical      records     of   consultation/
                                       Record/Statement of Service                                                           confinement and laboratory results for the
                                    Original/certified copy of approved leave                                               treatment of Hypertension
                                       application signed by employer or                                                    Original copy of Statement of Accounts
                                       certification as to inclusive dates of leave of                                       and itemized list and cost of all charges
                                       absence (with and without pay) signed by                                              during confinement
                                       employer.                                                                            Original official receipts for payment of
                                    Certified copy of all medical records of                                                hospital bills/doctor’s fees, medicines
                                                                                                                             purchased and other medical expenses
                                       consultation/confinement and laboratory
                                       results due to claimed ailment                                                     PTB
                                    Original copy of Statement of Accounts and                                             Income Benefit Claim for Payment parts I
                                       itemized list and cost of all charges during                                           and II
                                       confinement                                                                          Hospitalization Claim for Payment parts I,
                                    Original official receipts for payment of                                                II and III
                                       hospital bills/doctor’s fees, medicines                                              Original copy of Service Record/Statement
                                       purchased and other medical expenses.                                                  of Service
                                                                                                                            Certified copy of approved leave
                                      Hypertension/HCV/HASCVD/CAD/M.I/other                                                  application
                                       ailments                                                                             Certified copy of hospital/clinical records
                                        Income Benefit Claim for Payment                                                     due to PTB
                                           parts I and II                                                                   Chest x-ray film (latest)
                                        Hospitalization Claim for Payment parts                                            Certified copy of result of Sputum
                                           I, II and III                                                                      Examinations for AFB
                                        Original/certified copy of Service                                                 Original copy of Statement of Accounts
                                                                                                                              and itemized list and cost of all charges
                                           Record/Statement of Service                                                        during confinement
                                        Certified copy of approved leave                                                   Original official receipts for payment of
                                           application                                                                        hospital bills/doctor’s fees, medicines
                                        Certified copy of previous medical                                                   purchased and other medical expenses.
                                           records of consultation/confinement                                            PNEUMONIA
                                           and laboratory results for the treatment                                         Income Benefit Claim for Payment parts I
                                           of Hypertension                                                                    and II
                                        ECG tracings properly identified and 2D                                            Hospitalization Claim for Payment parts I,
                                           Echo/Stress Test if applicable                                                     II and III
                                        Original copy of Statement of Accounts                                             Original/certified copy of Service Record/
                                           and itemized list and cost of all charges                                          Statement of Service
                                           during confinement                                                               Certified copy of approved leave
                                        Original official receipts for payment of                                            application
                                           hospital bills/doctor’s fees, medicines                                          Certified copy of hospital/clinical records
                                           purchased and other medical expenses                                               due to Pneumonia
                                                                                                                            Chest x-ray film (latest)

				
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posted:9/14/2011
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