OCA CIRCULAR NO.
110-2011
TO All Judges and Personnel of,the Lower Courts
SUBJECT Acceptance of Application for Membership in
the Supreme Court Health and Welfare Plan
(SCHWP)
For the information and guidance of all concerned, quoted hereunder is
Resolution No. 2505 Series of 2011 dated June 17, 2011 of the Supreme Court
Health and Welfare Plan Board:
"WHEREAS, the Supreme Court Health and Welfare Plan
(SCHWP) Board learned that there are still Lower Court employees
whose claims were disapproved for not being member of the Plan;
WHEREAS, in 2009 the SCHWP accepted membership from July
to September 30, 2009 but many still failed to apply for membership
during the said period;
WHEREAS, to extend the benefits of the Plan to the Lower Court
employees who are not yet members of the Plan there is aneed to accept
the applications for membership of the said employees;
NOW, THEREFORE, LET IT BE RESOLVED AS IT IS HEREBY
RESOLVED to accept application for membership to the Plan within the
period, from July 1, 2011 to September 30, 2011;
IT IS RESOLVED FURTHER to circularize this Resolution to the
different Lower Courts."
Attached is an application form to be accomplished in duplicate by
interested court employees. The form shall be submitted to the RTC/MTC,etc.
Personnel Division of the Office of Administrative Services, Office of the Court
Administrator
Please be guided accordingly.
August 8,2011.
~k,,,,Cou rt Administrator
C ~ A P / M T ~ R / c i r c u l a r - S C H W P 2 0 11
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Republilc of the Philippines ,,,.
SUPREME COURT
Manila
For new employees: Please indicate if you are willing to join the SUPREME COURT
HEALTH AND WELFARE PLAN
YES NO
If the answer is yes, please fill up the following MEMBERSHIP INFORMATION AND
AUTHORIZATION SHEET (Pleast PRINT all information)
NAME POSITION
STATION . ,~,
HOME ADDRESS:
TEL. NO.: OFFICE HOME .FAX NO.
DATE OF BIRTH PLACE OF BIRTH
CIVIL STATUS NAME OF SPOUSE
OCCUPATION OF SPOUSE:
BUSINESS ADDRESS OF SPOUSE:
TELEPHONE NUMBER OF THE OFFICE OF SPOUSE
NAME OF BENEFICIARIES/ RELAI-IONSHIP DATE OF BIRTH
DEPENDENTS
Effectively immediately, I hereby authorize tile Supreme Court EDP Division/
RCAO Finance Division to deduct from my salary every month the amount of
P .representing my contribution to the SC Health and Welfare Plan.
Signature of Member
Date
SUBSCRIBED AND SWORN to before me this day of
20,. affiant exhibiting to me his/her Supreme Court Identification Card No. __
ADMINISTERING OFFICER