Forms Pension Resumption
Forms Pension Resumption
Forms Pension Resumption
INSTRUCTIONS: Ensure that the form is properly filled out and submit the duly accomplished form to the GSIS. Do
not leave any blank items.
WARNING: Direct or indirect commission of fraud, collusion, falsification, misrepresentation of facts, or any other
kind of anomaly in the accomplishment of this form, or in obtaining any benefit under this application shall be subject
to administrative, civil and/or criminal action. THIS FORM IS NOT FOR SALE.
Date:______________________________
Residential Address (House No., Street, Barangay, City/Municipality, Province and Zip Code) GSIS Business Partner (BP) No.
Date of Birth (mm/dd/yyyy) Place of Birth Gender Civil Status (Indicate if Married, Single,
Widow/Widower or Annulled)
If married, Name of Spouse: (Last Name, First Name, Middle Name) Basis of Retirement/Separation/Survivorship
Benefits:
____________________________________________________________
PD 1146 RA 8291 RA 7699
Date of Marriage: _______________________________________________
I understand that for submission through email, an online video call will be undertaken by the GSIS and
my preferred mode of online verification will be (Choose only one (1) mode by placing a check mark and
provide the complete contact details) and that I will provide prior confirmation for the approximate video
call schedule provided by the GSIS:
Viber Video Call through mobile number (please provide country code):____________________________
Date of Birth of Deceased (mm/dd/yyyy) Relation to Deceased Member Date of Death (mm/dd/yyyy)
Date of Retirement of Deceased Member Name and Address of Agency of the Deceased Member Civil Status at the time of Death
I confirm my understanding of the Privacy Policy of the GSIS pursuant to the requirements of Republic Act (R.A.) No.
10173, otherwise known as the Data Privacy Act, and consent to the manner of collection, use, access, disclosure and
processing of my personal and sensitive personal data by the GSIS (details of the GSIS Data Privacy Policy may be
found at https://www.gsis.gov.ph/gsis-privacy-statement/).
1. ____________________________________
_______________________________________
Signature of Applicant Thumb mark 2. ____________________________________
(if unable to affix signature)
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