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Certificate of Eligibility for Cash Aid

The document is a Certificate of Eligibility for Outright Cash assistance issued by the Crisis Intervention Section of DSWD Field Office VI. It certifies that the client has been deemed eligible for assistance after assessment and validation, detailing the amount of assistance and the type of aid provided. Confidential records related to the case are maintained, and the document includes sections for signatures of the client, social worker, and approving authority.

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Anna Lou Condes
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88 views1 page

Certificate of Eligibility for Cash Aid

The document is a Certificate of Eligibility for Outright Cash assistance issued by the Crisis Intervention Section of DSWD Field Office VI. It certifies that the client has been deemed eligible for assistance after assessment and validation, detailing the amount of assistance and the type of aid provided. Confidential records related to the case are maintained, and the document includes sections for signatures of the client, social worker, and approving authority.

Uploaded by

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

CRISIS INTERVENTION SECTION

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

CERTIFICATE OF ELIGIBILITY
(Outright Cash)

QN: PCN: Date:


MM DD YYYY
New Returning On-site Walk-in Referral Off-site Malasakit Center
Male Female
This is to certify that, ,
Kumpletong Pangalan ng kliyente (First Name Middle Name Last Name) Kasarian (Sex) Edad (Age)

and presently residing at


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

SELF
Relasyon ng Kinatawan sa Benepisyaryo (Relationship of the Representative to Beneficiary) Kumpletong Pangalan ng Benepisyaryo (First Name Middle Name Last Name)

Records of the case such as the following are confidentially filed at the Crisis Intervention Division (CID)

General Intake Sheet Medical Certificate/Abstract Laboratory Request Social Case Study Report
Justification Prescriptions Promissory Note Contract of Employment
Valid I.D. Presented Statement of Account Funeral Contract Certificate of Employment
Treatment Protocol Death Certificate Income Tax Return
Quotation/Chargeslip Death Summary Others
Discharge Summary Referral Letter

The Client is hereby recommended to receive FOOD assistance for FINANCIAL

in the amount of THREE THOUSAND PESOS Php. 3,000 CHARGEBLE AGAINST:

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 THREE THOUSAND PESOS Php 3,000


(Amount in words)
Medical Assistance Transportation Assistance Food Assistance
Funeral Assistance Educational Assistance Cash Relief Assistance

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

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DSWD Field Office VI,M. H Del Pilar, Molo, Iloilo City, Philippines 5000
Website: [Link] Tel Nos.: (033) 337 6221 Telefax: (033) 337 6221

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