Form No 03182014a AFB Funeral Benefits
Form No 03182014a AFB Funeral Benefits
Form No 03182014a AFB Funeral Benefits
03182014a-AFB
First Name
Middle Name
Religion
Male
Civil Status
Married
Single
Separated
Female
Status at the time of death
Active Member
Retiree
Widow/Widower
Pensioner
Middle Name
Religion
Cellphone No.
E-mail Address
First Name
Middle Name
Relationship
Cellphone No.
I hereby certify that the foregoing information are true and correct and the attached documents are authentic.
Witnesses to thumbmark:
1. _____________________________
________________________________________________
Right Thumbmark
(if unable to affix signature)
2. _____________________________
Claim proceeds shall be electronically credited to your eCard/UMID account and may be withdrawn from your nearest ATM. If
you have no eCard/UMID, the proceeds will be paid through check.
DOCUMENTARY REQUIREMENTS