Republic of the Philippines

Province of Kalinga
City of Tabuk
Barangay Bulanao Centro

AUTHORIZATION

TO WHOM IT MAY CONCERN

This is to authorize Mr/Mrs _______________________, my ________________ to

receive my social pension from the Department of Social Welfare and Development (DSWD)

Given this ________ day of _______________, 2017 at __________________________.

____________________________________
Signature/Thumbmark of Pensioner Over Printed Name

Witness: ______________________________ (Brgy Official)

(Signature over Printed Name)

Republic of the Philippines

Province of Kalinga
City of Tabuk
Barangay Bulanao Centro

AUTHORIZATION

TO WHOM IT MAY CONCERN

This is to authorize Mr/Mrs _______________________, my ________________ to

receive my social pension from the Department of Social Welfare and Development (DSWD)

Given this ________ day of _______________, 2017 at __________________________.

____________________________________
Signature/Thumbmark of Pensioner Over Printed Name

Witness: ______________________________ (Brgy Official)

(Signature over Printed Name)