Republic of the Philippines

CIVIL SERVICE COMMISSION

Regional Office No. VIII
Candahug, Palo, Leyte

VERIFICATION REQUEST FORM

Name
Date of Birth
Place of Birth
Title of Exam/Type of Eligibility
Date of Exam/ Effectivity
Place of Exam/Issue
Date of Release/Issue
Page No.
SequenceNo.
Examinee No./ Certificate No.
Rating

Picture Seat Plan In Order Picture Signature Date of Birth

Not in Order Picture Signature Date of Birth
Remarks

VERIFIED BY:

CHECKED BY: