AUTHORIZATION

This is to authorize in my behalf, Mr. PELAGIO TAPIC LOPEZ, SR.

First Name Middle Name Surname

______HUSBAND ___,__ 80 YRS. OLD____ of __ _Tibiawan, Makato, Aklan_____.

Relationship to Beneficiary Age Address

To attend the validation of the Unconditional Cash Transfer(UCT) grant at Sports Complex due

to

the reason that I am not able to walk because of scoliosis and I also have high blood pressure.
State the reason for the Absence

___________________________________ _________________________________
Signature over Printed Name of Beneficiary Signature over Printed Name of
Authorized Representative

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Signature over Printed Name of Brgy. Captain Signature over Printed Name of OSCA