PROVINCE OF PAMPANGA R.I.S No.

: __________________
PROVINCIAL SOCIAL WELFARE & DEVELOPMENT OFFICE MALE : 1
FOOD ASSISTANCE DISTRIBUTION SHEET FEMALE : 1
City/Municipality : Porac Sapang Uwak High School TOTAL : 2
Gender
No. Name of Beneficiaries Address Assistance Extended Signature
M F
1 GOMEZ, EMMANUEL B. CANGATBA PORAC, PAMPANGA / 1
2 SANTIAGO, IRENE C. SAPANG UWAK, PORAC, PAMPANGA / 2
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Distributed by : ________________________ Certified by : EMMANUEL B. GOMEZ

Signature over Printed Name
Designation: ___________________________ Designation: School Head/ Principal

DATA PRIVACY CONSENT : By signing this Information sheet/form,you are hereby giving your consent to PSWDO to collect/process your personal data. Page _____ of _____
 PROVINCE OF PAMPANGA R.I.S No. : __________________
PROVINCIAL SOCIAL WELFARE & DEVELOPMENT OFFICE MALE : 1
FOOD ASSISTANCE DISTRIBUTION SHEET FEMALE : 4
City/Municipality : Porac Sapang Uwak High School TOTAL : 5
Gender
No. Name of Beneficiaries Address Assistance Extended Signature
M F
1 ANDRES, MARIFE C. SAPANG UWAK, PORAC, PAMPANGA / 1
2 BERNARDO, JUNIEFER B. BABO PANGULO, PORAC, PAMPANGA / 2
3 EROLIN, LIEZL C. BABO SACAN, PORAC, PAMPANGA / 3
4 PALABASAN, HAZEL B. MANIBAUG, PORAC, PAMPANGA / 4
5 VALENCIA, CHONA T. CALZADANG BAYU, PORAC, PAMPANGA / 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20

Distributed by : ________________________ Certified by : EMMANUEL B. GOMEZ

Signature over Printed Name
Designation: ___________________________ Designation: School Head/ Principal
DATA PRIVACY CONSENT : By signing this Information sheet/form,you are hereby giving your consent to PSWDO to collect/process your personal data. Page _____ of _____