REQUEST FORM FOR ISSUANCE OF DILG CERTIFICATION

JOY J. VALLA
Municipal Local Government Operations Officer
DILG San Enrique

The undersigned would like to request for a DILG Certification for:

NAME: SALVACION P. SOLINA Barangay: III

Position: BARANGAY SECRETARY (Elective Officials, Barangay Secretary, Barangay Treasurer)

with the following details and attachments:

FOR BARANGAY
FOR ELECTIVE OFFICIALS SECRETARY AND Check () if attached
TREASURER (including SK
DATE OF Sec. and SK Treas.)
TERM ELECTION DATE OF POSITION DATE DATE OF OATH APPOINTMENT
ASSUMPTION APPOINTED ASSUMPTION OF (for
TO OFFICE TO OFFICE appointive
OFFICE
officials only)
2018- May 14, Jun 30, 2018
Present 2018
2013-2018 Oct 23, Nov 30, Barangay
2013 2013 Secretary
2010-2013 Oct 25, Nov 30,
2010 2010
2007-2010 Oct 29, Nov 30,
2007 2007
2002-2007 Jul 15, Aug 30,
2002 2002
1997-2002 May 12, Jun 30, 1997
2007
for the following purpose (please check):
 Certificate of Incumbency  Certification for Civil Service Eligibility
 Certificate of Incumbency (for scholarship of children)
 Certificate of Incumbency for Loan purposes  DILG Certification (for services rendered)
 DILG Certification for other purpose(s) (please state purpose )________________________________

REQUESTED BY: Salvacion P. Solina

Printed Name over Signature
Contact Number: 0999-586-2569
Email Address (if any): psalvacion0119@gmail.com
BARANGAY: III
Remarks on the request:

JOY J. VALLA

RECEIVED BY: ______________________________

Signature over Printed Name
Date Received: ______________________________