Claim Form Data Entry

Please enter your details (fields marked with "*" are required):

Bank Details
Bank Name: * Branch:

Depositor Details
Type of Depositor: * Individual    Business Entity
Name of Depositor: *
For Individual Depositor, enter name in the format: Last Name, First Name Middle Name
For Business Entity, enter the name of Business/Corporation/Association
Date of Birth: * Email Address: *
Home Phone: Mobile Phone: *
Spouse's Name: * Mother's Maiden Name: *

Account Number
Account #1: * Account #2:
Account #3: Account #4:

Complete Mailing Address
House No.: Street:
Barangay: * Town/City: *
Province: * Zip Code:

Deposit Insurance Payment Options


Please check one:
A check payment is issued for payee's account only and for deposit with any local bank. The check is available for pickup by the depositor or a duly authorized representative with SPA at PDIC or may be sent through registered mail delivered to addressee only.
Note: For Business Entity, the only available payment option is CHECK for payee's account only.
Cash Over the Counter (COTC) at the LBP
COTC is CASH payment disbursed by a designated LBP Servicing Branch to depositor only.
Credit to depositor's existing bank account
A secured electronic fund transfer directly credited to depositor's existing personal bank account. Corresponding bank charges may be imposed.

Name of Bank:
Account Name:
Account Number:

Electronic Money Issuers (EMIs)
Deposit insurance payment will be transferred through GCash, Paymaya, or DCPay. To opt for the EMI, the account should be registered in the name of the depositor and the limit should be able to accommodate the amount of insurance payment to be transferred to the EMI account.

GCash Account Name: Account Number:
PayMaya Account Name: Account Number:
DCPay Account Name: Account Number:

LBP Cash Card
The Cash Card is a stored value card containing the amount of the insured deposit which can be withdrawn via Automated Teller Machine (ATM). It has a combination functions of debit card and an ATM. Depositor can withdraw with any bank. The PIN Mailer and the Cash Card are released directly to the depositor through personal pick up at PDIC.
Outgoing Telegraphic Transfer (OTT) - Recommended for depositors residing abroad
The OTT is the remittance of insured deposit payment to depositor's dollar account abroad. Depositors to coordinate with PDIC thru for the requirements. Bank charges imposed by the bank will be for the account of the depositor.


US Dollar (USD)
Deposit insurance payment in dollar will be released by a designated Land Bank Servicing Branch to be personally claimed by the depositor.
Philippine Peso (PhP)
Depositor may opt to be paid in Philippine Peso. Please refer to options under Peso Account. Conversion rate shall be based on the prevailing rate as of the closed bank takeover date.