modified form. mas cancellation

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  • 7/23/2019 Modified Form. MAS Cancellation

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    PHILIPPINE PUBLIC SCHOOL TEACHER ASSOCIATION245 Banawe St., corner Quezon Ave., Quezon City

    MAS Claims Department(02) 988-1400-99/0917-57150 !/0905-5 55858/0918-44 9122/0918-544804!

    APPLICATION ORMCANCELLATION O MUTUAL AID S!STEM (MAS) MEMBERSHIP

    "A#$% &&&&&&&&&&&&&&&&

    #'% PHILIPPINE PUBLIC SCHOOL TEACHERS ASSOCIATION245 Banawe St., Quezon City

    #(i) i) to re*ue)t +ro your o++ice t(e cance ation o+ y AS e er)(i un er Certi+icate &&&&&&&&&&&&&& an to wit( raw t(e corre) on in3 e*uity va ue e)) in e te ne)).

    IN CASE O RETIREMENT PLAN MEMBERSHIP"

    Up#n $an$ellati#n #% m& MAS mem'ers ip m& MRBS an*+#r NMRBS mem'ers ip i% an& ,ill als# 'e a-t#mati$all& $an$elle*.

    un er)tan t(at t(e ter ination o+ y AS e er)(i )(a ta e e++ect u on recei t o+ t(i)a ication y 66S#A.

    un erta e to in+or y ene+iciarie) / e3a (eir) t(at t(ey wi no on3er receive any ene+it +ro66S#A in view o+ t(e ter ination o+ y e er)(i .

    &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&&AS e er Si3nature over rinte na e "ivi)ion o. : Station o. : $ oyee o.

    &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&& "ate o+ Birt( o+ e er Contact u er

    &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&ai in3 A re))

    ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

    *This application must be originally signed by the applicant.*The signature in this application must be similar with the applicants signature in the valid IDs that he/she will submit.

    Re -irements" #r RETIRED(t# 'e atta$ e* t# t is appli$ati#n %#rm)

    1. 'ri3ina AS certi+icate, in ca)e o+ o)), ori3ina y)i3ne a++i avit o+ o))

    2. 6(otoco y o+ ;S S ateService

  • 7/23/2019 Modified Form. MAS Cancellation

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