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    Aics Akap Ce

    Uploaded by

    Mayrose Damo

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    © All Rights Reserved
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    Aics Akap Ce

    Uploaded by

    Mayrose Damo
    5 views2 pages

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    5 views2 pages

    Aics Akap Ce

    Uploaded by

    Mayrose Damo

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    STATUTORY PROGRAMS DIVISION

    FIELD OFFICE 1
    DSWD-PMB-GF-013 | REV 03 | 14 MAY 2024

    CERTIFICATE OF ELIGIBILITY

    Kumpletong Pangalan ng kliyente (First Name Middle Name Last Name) Kasarian (Sex) Edad (Age)

    and presently residing at ,ILOCOS NORTE

    Kumpletong Tirahan (Complete Address)

    has been found eligible for assistance after the assessment and validation conducted, for his/herself or in representation of his/her

    Conforme: Prepared by: Approved by:

    Client Social Worker Approving Authority


    (Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name)

    Acknowledgement Receipt
    MM DD YYYY

    Date:

    Financial Assistance THOUSAND PESOS Php


    (Amount in words)

    MedicalAssistance Transportation Assistance


    FuneralAssistance

    Tinanggap ni: Binayaran ni: Sinaksihan ni:


    Client RDO / SDO SWO / ADMIN
    (Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name)

    *E.O 163 series 2022

    Page 1 of 1
    DSWD Field Office 1, Quezon Avenue, City of San Fernando, La Union, Philippines 2500
    Website: fo1.dswd.gov.ph Tel Nos.: (072) 687 - 8000 Telefax: (072) 888- 2184

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