DATE

GOVERNMENT SERVICE INSURANCE SYSTEM

Regional Office VIII
Tacloban City

REQUEST FOR WITHDRAWAL OF APPLICATION

I, ____________, hereby request the withdrawal of my application,

dated _______, for the reason that after checking with GOVERNMENT
SERVICE INSURANCE SYSTEM (GSIS), account number: XXXXXXXXXX, I
was informed that I have not yet completed the 15-year membership and or
contribution to be entitled or to avail of the GSIS retirement benefit, with
only 3 years lacking. I intend, therefor, to continue working until I am able
to complete the 15-year period of membership and or contribution required
and reapply thereafter to avail of the said retirement benefit.

I have been advised of the alternatives to withdrawal for applicant

under full retirement age and still wish to withdraw my application.

I understand that this request may not be cancelled after certain

period set by the GSIS from notice of approval.
I further understand that the application withdrawn and all related
material will remain a part of the records of the GSIS and that this
withdrawal will not affect the proper crediting of contributions, wages or
self-employment income to my GSIS earnings record.
Thank you for your consideration.

Sincerely,

NAME GSIS APPLICANT