_________________________

Date

AUTHORIZATION LETTER

I, ____________________________________, recipient of Social Pension Stipend, of legal age,

presently under the custody of my Child/Relative, ____________________________________
in Barangay Catumsan, Arteche, Eastern Samar, with contact number _____________________,
authorizes my __________________________________,
___________________________________ who is presently residing in Barangay Catumsan,
Arteche Eastern Samar, to claim my stipend in the amount of _________________ for the first
Semester 2021 subsidy from the government due to reason stated below.

- Bedridden
- Sick
- With physical disability
- Lockdown in other areas
Please specify the area ___________________
That I am fully aware that he/she will affix his/her signature in the payroll for and in my behalf.
Thank you.

__________________________________
Signature over printed name of beneficiary

Confirmed by:

__________________________________________
Signature over printed name of Authorized Representative

Attested by:

MRS. ROSALINA C. ABIANDA

Signature over printed name SC Brgy. Chapter President