CS Form No.

4
Revised 2018

Republic of the Philippines

__(Name of Agency)__

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Mr. BENEDICTO CESAR Y ANDOJAR has

assumed the duties and responsibilities as Barangay Captain of
_____________________________ effective _________________.

This certification is issued in connection with the issuance of the Order

of Release of Mr. BENEDICTO CESAR Y ANDOJAR by Executive Judge
Igmedio Emilio F. Camposano dated November 16, 2022.

Done this ____ day of __________ ________ in ______________.

________________________
Head of Office/Department/Unit

Date: ________________

Attested by:

________________________
Highest Ranking HRMO

201 file
Admin
COA
CSC For submission to CSCFO
within 30 days from the
date of assumption of the
appointee