AUTHORIZATION

This is to authorize in my behalf my ________________, ___________________________,

(Relationship to beneficiary) (First Name, Middle Initial, Last Name)

______, of __________________________________to claim/receive my UCT grant amounting to

(Age) (Address of Representative)

THREE THOUSAND SIX HUNDRED PESOS ONLY (PHP3,600.00) due to_______________________.

(State the Reason for the absence)

___________________________________ ___________________________________
Signature Over Printed Name of Beneficiary Signature Over Printed Name of Authorized
Representative

Authorized representative identified and guaranteed to receive the grant.

_________________________________ ____________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO
_____________________________________________________________________________________
To be filled-out only to those who are not related up to 2nd degree of consanguinity

Verified and Guaranteed:

_____________________________________ ______________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO

AUTHORIZATION

This is to authorize in my behalf my ________________, ___________________________,

(Relationship to beneficiary) (First Name, Middle Initial, Last Name)

______, of __________________________________to claim/receive my UCT grant amounting to

(Age) (Address of Representative)

THREE THOUSAND SIX HUNDRED PESOS ONLY (PHP3,600.00) due to_________________________.

(State the Reason for the absence)

___________________________________ ___________________________________
Signature Over Printed Name of Beneficiary Signature Over Printed Name of Authorized
Representative

Authorized representative identified and guaranteed to receive the grant.

_________________________________ ____________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO
_____________________________________________________________________________________
To be filled-out only to those who are not related up to 2nd degree of consanguinity

Verified and Guaranteed:

_____________________________________ ______________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO