Date: _______________

This is to certify that Ms./Mr. _____________________________ with HH Id number

_________________________ tagged as CS 15-No Eligible Member of HH for CVS monitoring has still an

eligible child for monitoring for (educ/health) with pertinent documents attached herewith.

With this, the undersigned is requesting for the reactivation of HH.

_____________________________
(Printed Name & Signature of C/ML)

Attachments: Update form, School/Health Cert, Birth Certificate (for additional member), CAR (for hhs
whose current monitored child will be deselected and replaced using HS graduate/overage as reason for
replacement)

-------------Guide for reactivation process of CS 15 HHs------

Additional members eligible for monitoring must be:

-Anak/Apo ng Head
-0-18 years’ old
-with at least one parent in roster
-attending health facility (for 0-5yo)
-enrolled and attending school (for 3-18yo or 6-18 yo)

Current monitored members may be replaced using the following reasons:

-Deceased (attach copy of death cert)
-Disability (attach copy of health cert/PWD ID)
-With full academic scholarship (attach proof of scholarship)
-Overage (attach copy of birth cert if age is not updated & CAR)
-High School Graduate (attach copy of diploma & CAR)