Bi-Annual Submission of Pensioner's Survey Form

January 17, 2017

OCA CIRCULAR NO. 10-2017

 

In a number of occasions, pensioners (both Judges and surviving spouses of Judges), have raised their concerns on the delayed or non-receipt of monthly pensions/survivorship pensions. This has been traced to the late or non-submission of Pensioner Survey Forms.

To show proof of life and pension entitlement, a duly-accomplished Pensioner's Survey Form (copy attached), together with the supporting documents, is required on a bi-annual basis, or in January and July of every year, before the monthly pensions are released.

To avoid delay in the release of monthly pensions, all Judges Pensioners and Survivorship Pensioners are strictly enjoined to REGULARLY SUBMIT every January and July of every year to the Employee's Welfare and Benefits Division (EWBD), Office of Administrative Services (OAS), Office of the Court Administrator (OCA), Supreme Court, Manila, the following:

1. Duly-accomplished sworn Pensioner's Survey Form administered by the Executive/Presiding Judge having jurisdiction over the place of pensioner's residence;

2. Most recent full-body picture of the pensioner holding the front page of the most recent issue of a newspaper of national circulation (any size);

3. Original copy of the broadsheet's front page held in photo; and

4. Copies of at least two (2) current identification cards/documents issued by an official agency bearing photograph and signature of the pensioner, such as Senior Citizen's card, Passport, Driver's License, PRC ID, Postal ID, or any government office ID.

Inquiries relative to the Pensioner's Survey Form may be coursed to the EWBD, OAS, OCA at contact number (02) 5234893.

For strict compliance.

This Circular shall take effect immediately.

(SGD.) JOSE MIDAS P. MARQUEZ

Court Administrator

 

 

ATTACHMENT

 

 

PENSIONER'S SURVEY FORM(retired Judge)

Name:	_______________	_______________	_______________
	First Name	Middle Name	Last Name
Date of Birth:	__________	__________	__________	Sex:	__________
	Month	Day	Year
Mailing Address:	__________________________________________________________
Contact Number/s (Pensioner):	____________________
Contact Person:	______________________	Contact Number/s:	________________
Relationship:	____________________
Specimen Signatures (Pensioner):	l. _______________ 2. _______________
Current Marital Status:	___________	If Remarried, Date of Marriage:	_____________
Name of Spouse:	_________________________________
Identification Cards Presented:	1. __________________ 2. __________________

 

I hereby declare under oath, that: aScITE

1. I shall not, during the period that I am receiving the pension, appear as counsel before any court in any civil case wherein the Government, or any subdivision or instrumentality thereof is the adverse party, or in any criminal case wherein an incumbent or former officer or employee of the government is accused of an offense committed in relation to his/her office, or collect any fee for my appearance in any administrative proceedings;

2. I shall not, upon assumption to an elective public office and during my term, receive the monthly pension due me; and

3. I shall immediately inform the Office of the Court Administrator, through the Employee Welfare and Benefits Division, Office of Administrative Services, Supreme Court of such assumption to office.

By affixing my signature/thumbmark below, I certify that the following information given by me is TRUE and CORRECT to the best of my knowledge and belief and that any material misrepresentation or falsity therein shall be construed as an act of fraud to the Supreme Court for which civil and criminal liability can be pursued against me.

	Note: If pensioner cannot sign, thumbmark
	must be witnessed by two (2) persons.
______________________________	1. __________________________
Signature over Printed Name
	2. __________________________

 

PENSIONER'S SURVEY FORM(surviving spouse of the deceased Judge)

Name:	_______________	_______________	_______________
	First Name	Middle Name	Last Name
Date of Birth:	__________	__________	__________	Sex:	__________
	Month	Day	Year
Mailing Address:	__________________________________________________________
Contact Number/s (Pensioner):	____________________
Contact Person:	_______________________	Contact Number/s:	________________
Relationship:	_________________________
Specimen Signatures (Pensioner):	l. _______________ 2. _______________
Current Marital Status:	____________	If Remarried, Date of Marriage:	____________
Name of Spouse:	____________________
Identification Cards Presented:	1. __________________ 2. _________________

 

I hereby declare under oath, that:

1. I have not contracted another marriage;

2. I shall not, during the period that I am receiving the survivorship pension, appear as counsel before any court in any civil case wherein the Government, or any subdivision or instrumentality thereof is the adverse party, or in any criminal case wherein an incumbent or former officer or employee of the government is accused of an offense committed in relation to his/her office, or to collect any fee for my appearance in any administrative proceedings;

3. I shall not, upon assumption to an elective public office and during my term, receive the monthly pension due me; and

4. I shall immediately inform the Office of the Court Administrator, through the Employee Welfare and Benefits Division, Office of Administrative Services, Supreme Court of such assumption to office.

By affixing my signature/thumbmark below, I certify that the following information given by me is TRUE and CORRECT to the best of my knowledge and belief and that any material misrepresentation or falsity therein shall be construed as an act of fraud to the Supreme Court for which civil and criminal liability can be pursued against me.

	Note: If pensioner cannot sign, thumbmark
	must be witnessed by two (2) persons.
______________________________
Signature over Printed Name	1. __________________________
	2. __________________________

 

SUBSCRIBED AND SWORN to before me this ___ day of ___________, 20___, at _____________________________________________, affiant exhibited to me his/her _____________________ Identification Card bearing No. _____ as competent evidence of identity. HEITAD

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