Kaligtas Program

I. MEMBER’S INFORMATION:

Name
Name
First Name
Middle Name
Last Name
Philippine Address
Philippine Address
Municipality / City
Province
Zip/Postal
Country

Maximum file size: 516MB

II. LIST OF BENEFICIARIES:

Are you married?
Spouse Name
Spouse Name
First Name
Middle Name
Last Name
Name of Children 1
Name of Children 1
First Name
Middle Name
Last Name
Name of Children 2
Name of Children 2
First Name
Middle Name
Last Name
Name of Children 3
Name of Children 3
First Name
Middle Name
Last Name
Name of Father
Name of Father
First Name
Middle Name
Last Name
Name of Mother
Name of Mother
First Name
Middle Name
Last Name


IN CASE OF EMERGENCY

Name
Name
First Name
Last Name
Philippine Address
Philippine Address
Municipality / City
Province
Zip/Postal
Country

III. POLICY DETAILS: [For KA-LIGTAS Committee Only.]


POLICY NO. DATE FILED
COVERAGE: 1 YEAR EFFECTIVITY DATE: EXPIRATION DATE:
PREMIUM AMOUNT SAR 100 INSURANCE TYPE DEATH / HOSPITALIZED / AFFECTED BY NATURAL DISASTERS
If Premium Amount is depleted or reach to 10% of the remaining amount. Pays SR 100 payable in 2 Months term. MEMBER 1ST DEGREE
SR 10 x 50% of Member’s Benefit 50% of Member’s Benefit
QUALIFICATIONS:
(1) All members are encouraged to join by signing up the Ka-Ligtas Application form and submit to the Chapter Ka-Ligtas Coordinator.
(2) Must be an active member of FASPI (Chapter). (3) FASPI ID is valid. (4) Pays the Ka-Ligtas Contribution amounting to SAR 100 to the Chapter Ka-Ligtas Coordinator
or a committed by the Chapter President. If the remaining Ka-Ligtas fund reaches 10%, the Ka-Ligtas coordinator will start collecting SR 100 to replenish
the Ka-Ligtas Fund and to sustain the program; the said amount is payable in 2 months term. (4) Subject to the deliberation of the Chapter Presidents.
(5) Has no pending administrative case.
POLICY CONDITION
(1) Year validity upon application to Ka-Ligtas Program, Annual claim of each type and can avail once in every claim type
IV. CONFORME:
MEMBER’S COMPLETE NAME DATE
SIGNATURE APPROVED BY: NATIONAL FOUNDING PRESIDENT

KA-LIGTAS APPLICATION FORM-001