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Certificate of Eligibility for Assistance

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Mayrose Damo
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52 views2 pages

Certificate of Eligibility for Assistance

Uploaded by

Mayrose Damo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

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: [Link] Tel Nos.: (072) 687 - 8000 Telefax: (072) 888- 2184

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