Attachment No.

2 – Template for Correction

Republic of the Philippines

Region 3
Province
City/Municipality
Barangay

CERTIFICATION
This is to CERTIFY that is a resident of
, (age), (status), is in need of Social Amelioration
Program – Emergency Subsidy from the Department of Social Welfare and Development due
to the declaration of State of Calamity / imposition of Community Quarantine during this
pandemic COVID 19 crisis.

It is further certify that: (check whichever is applicable)

No Valid I.D.

___________________________ and _____________________

is one and the same person.

his/her correct birthday is and not ________________.

(deceased / person with disability/ senior citizen / pregnant women) beneficiary

____________ and his/her family member included in the SAC Form is authorized to
claim the SAP grant.

Signed this of 2020 at for the purpose of

claiming his/her SAP-ESP.

Certified by:

MARYBETH M. ORTIZ, RSW

Barangay Captain Local Social Worker Officer (LSWDO)

Concurred by:

PTL/PL/ML/CMAT/SWD-III/SLP-PC