Authorization

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AUTHORIZATION

This is to authorize in my behalf,____________________________,____________


First Name,Middle Name,Surname Relationship

____________of ______________________________________to claim/receive


Age Address

my pension due to___________________________________________.


State the reasons for the absences

___________________________________ ____________________________

Signature/Thumbmark Over Signature Over Printed Name of

Printed Name of Beneficiaries Authorized Representative

Attested by:

_____________________________________

MSWDO/CSWDO

_____________________________________

OSCA
CERTIFICATION

This is to certify that,_________________________________________,


First Name Middle Name Last name

_____of __________________________________can no longer sign in the Social


Age Address

Pension payroll covering the months of____________________CY__________in


the amount of Php______________due
to________________________________.
( State the reason )

Issued this_______day of________________at Tinapian,Manito Albay for


reference purposes.

Attested by;

_______________________
BASCA-President

_______________________
MSWDO/CSWDO

________________________
OSCA-President

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