AUTHORIZATION

This is to authorize in my behalf, ____________________________________, ____________________,

First Name, Middle Name, Surname Relationship to beneficiary

____ of _____________________________________ to claim/receive my social pension amounting to

Age Address

Php1,500.00 for the period of _______________________ due to _______________________________.

(Month covered) (State the reasons for absences)

________________________ __________________________
Signature / Thumbmark Over Signature Over Printed Name of
Printed Name of Beneficiary Authorized Representative

Attested By:

CHADY M. CERBITO
MSWDO

NAPOLEON A. FUNTELAR
OSCA