Deceased Beneficiary

Republic of the Philippines

Province of Leyte
Municipality of Babatngon
BARANGAY _____________________
-o0o-

C E R T I F I C A T I O N

Picture of the
representative/
claimant

______________________
Signature

THIS IS TO CERTIFY that ____________________________________, _____

years old, (Name) (Age)
________________, whose picture and signature appears above, is residing at _________________
(Civil status)
_________________________. That he/she is the ______________________________ and
(Relationship to senior citizen)
currently the custodian/caretaker of ____________________________.
(Name of the senior citizen)

That he/she is being authorized by the bereaved family to transact & claim the stipend intended for
the social pension beneficiary.

This certification is issued for whatever purpose it may serve.

Issued this ______ day of ________, 2022.

___________________________________
Punong Barangay