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DSWD Certificate of Eligibility for Aid

This document is a Certificate of Eligibility for cash relief assistance issued by the Crisis Intervention Section of DSWD Field Office VIII. It certifies that an individual has been assessed and found eligible for financial assistance of five thousand pesos. The document includes details about the client, their relationship to the beneficiary, and the necessary confidential records filed for the case.

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Ruel Delgado
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117 views2 pages

DSWD Certificate of Eligibility for Aid

This document is a Certificate of Eligibility for cash relief assistance issued by the Crisis Intervention Section of DSWD Field Office VIII. It certifies that an individual has been assessed and found eligible for financial assistance of five thousand pesos. The document includes details about the client, their relationship to the beneficiary, and the necessary confidential records filed for the case.

Uploaded by

Ruel Delgado
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

CRISIS INTERVENTION SECTION

FIELD
Medical Assistance OFFICE VIII
Transportation Assistance
Funeral Assistance
DSWD-PMB-GF-013 Educational
| REV 03 | 14 MAY 2024 Assistance

CERTIFICATE OF ELIGIBILITY
(Outright Cash)
QN: PCN: Date:
MM DD YYYY
AICS AKAP New Returning On-site Walk- in Referral Off-site Malasakit Center

This is to certify that, , Male Female


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

and presently residing a

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 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 CERT. OF INDIGENCY Discharge Summary
Referral Letter
The Client is hereby recommended to receive CASH RELIEF ASSISTANCE for OTHER NEEDS S

in the amount of FIVE THOUSAND PESOS Php. 5,000.00 CHARGEBLE AGAINST: PSP 2025

Conforme: Prepared by: Approved by:

ANNA S. ABAN
Client Social Worker Approving Authority
(Signature over Printed Name) License Number: (Signature over Printed Name)
(Signature over Printed Name)

Acknowledgement Receipt

MM DD YYY
Y
Date:
Financial Assistance FIVE THOUSAND PESOS Php 5,000.00

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 VIII, Government Center, Candahug, Palo, Leyte, Philippines 6501
Email: fo8@[Link] Website: [Link] Telephone No. (053) 552-3698

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