AUTHORIZATION

TO WHOM IN MAY CONCERN:

This is to authorize Mr, /Mrs.______________________________ to receive on my behalf my

(Name of Authorized Representation)
Social Pension Stipend for the period of__________________________ amounting to
[Month covering the stipend} [Amount to receive}

from the Department of Social Welfare and Development-Cordillera Administration Region

due to ____________________________________________________________
(Reasons/of inability to personally claim the stipend}

Given this_________ day of ______ at _________________________________________.

_______________________________________
Signature/Thumbmark over the printed name of
Social Pension Beneficiary

Republic of the Philippines

Cordillera Administrative Region
Province of Abra
Municipality of Tineg

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that ___________________________________ cannot claim his/her Social Pension
(Name of Social Pension Beneficiary)
due to _____________________________________________________________________.
(Reason/s of inability to personally claim his/her stipend)

Further certify that ______________________________ is the one taking care of the senior citizen.
(Name of Authorized Representative)

This certification is issued to support the claim of Social Pension from the Department of Social Welfare and
Development – Cordillera Administrative Region.
Issued this ________ day of_____________ at_________________________________________.

Signature Over Printed Name of Punong Barangay Signature Over Printed Name of Concerned
Relatives or Neighbour