√9“ANNEX D”

(Provision/Non-provision of Food, Board and Lodging)

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

Field Office-MIMAROPA

CERTIFICATION

To whom it May Concern:

This is to certify that Mr./Ms._____________________________________ of the
_______________________ has personally appeared to this office on
_____________________ for the
__________________(Purpose)____________________________________________.
It is further certified that during the visit/stay of the above-mentioned name, this office:

Please affix your Particulars Inclusive date

signature on
appropriate box
√ Did not provide hotel/lodging, food and
meals

Provided the following:

Hotel/Lodging Accommodation
Meals
Breakfast
Lunch
Dinner

√ Did not provide vehicle

Provided vehicle

This certificate is issued upon request of the interested party for the purpose of establishing the
evidence and duration of his/her appearance here at, the truth of which is hereby vouchsafed
and guaranteed by the undersigned.
Done in____________________________________ on _______________________
(place of issue) (date of issue)

__√______________________________
Signature over Printed Name
Note:

This certificate shall be issued by Field Office Director or his/her authorized representatives to officials or employees on official
travel in accordance to paragraph 1.3 of Memorandum Circular 37, series of 2004 on Austerity Measures and shall be one of the
basis for collecting allowable travel expenses.