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Siaton Funeral Homes™

A St. Peter Chapel Franchisee


Main Branch: Nat’l highway, cor. Rizal St., Brgy. 2
Poblacion Siaton, 6219 Negros Oriental
Contact Number: (0917) 314-1498/ (0995) 086-8602
e-mail address: siatonfuneral@yahoo.com

ACKNOWLEDGMENT
This is to acknowledge receipt in the sum amount of _________________________________
(PhP _______________.00), from the Siaton Funeral Homes Management, as Full Reimbursement
representing the burial assistance from the Department of Social Welfare and Development (DSWD)-
Field Office- 7, for the late ___________________________________,

today, __________________________________, at _______________________________,


Negros Oriental, Philippines.

______________________________
Signature over printed name

_______________________________
Date

_______________________________
Address

________________________________
Contact Number

N.B. Please refer to Cash Voucher No. ____________________ for reference on the details of the
aforementioned reimbursement. Xxx

xxx

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