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Republic of the Philippines

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT


CRISIS INTERVENTION UNIT

CERTIFICATE OF ELIGIBILITY

Client ID: 3778300


September 17, 2020

This is to certify that IRENE SABES PATUGA, FEMALE, 33 year/s old and presently residing at BRGY. SABANG, BALER,
AURORA, has been found eligible for financial assistance for HER FAMILY after a thorough assessment has been conducted.

Records of the case such as the following are confidential filed at the Crisis Intervention Unit.

GENERAL INTAKE SHEET FIRE INCIDENT CERTIFICATION


RFEFERRAL LETTER PHOTO OF FIRED HOUSE
SOCIAL CASE STUDY REPORT
JUSTIFICATION
VALID ID PRESENTED:
VOTERS ID
BRGY CERTIFICATE/BRGY
INDIGENCY
OTHERS:

The client hereby recommended to receive OTHER CASH ASSISTANCE/FIRE VICTIM for the purpose of FOOD ALLOWANCE
AND OTHER BASIC NEEDS in the amount of EIGHT THOUSAND PESOS (PHP 8,000.00)

Chargeable Against: CURRENT FUND


Clientele Category: FAMILY HEADS AND OTHER NEEDY ADULT
Mode of Admission: REFERRAL

Prepared by:

Emie A. Dela Rosa


Lic No: 0012002
SWOII/EAICS

CONFORME: APPROVED BY:

IRENE SABES PATUGA Corazon T. Virrey


Signature over Printed Name Lic No: 0007753
REQUESTING PARTY SWO II/PT LEADER
ACKNOWLEDGEMENT RECEIPT

PETSA: September 17, 2020


Natanggap ko ang halagang WALONG LIBONG PISO (Php 8,000.00) mula sa Department of Social Welfare and
Development (DSWD) OTHER CASH ASSISTANCE

TINANGGAP NI: BINAYARAN NI: SINAKSIHAN

IRENE SABES PATUGA


Pangalan at lagda Pangalan at lagda Pangalan at lagda

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