CERTIFICATION

This is to certify that I, (Name of Student),

(course/year/section), enrolled for the 1 st Semester
AY 2021-2022 at Bohol Island State University (BISU) Main campus, received the amount of One
Thousand Fifty Pesos (Php 1050.00) as communication allowance for the months of October to
December, 2021 and that I, shall utilize the said amount solely for the communication purposes
directly related to the subjects/programs that I am enrolled for the semester.

Signature over printed name

Contact #:

Date:

AUTHORIZATION

I, _________________________________(name of student), _______________

(course/year/section), 1 st
Semester AY 2022-2023, a resident of
_________________________________ (address).

I hereby authorize my _________________(relationship), _______________________(name

of the person authorized), to claim my load allowances from BISU Main Campus amounting to Nine
Hundred Pesos (Php900.00)for the reason of:
o It will be very costly for me to travel to Tagbilaran City to pick up the said amount;
o It is impossible for me to travel to BISU since I am currently out of the province;
o Others (pls specify: ___________________________________________

Signature over printed name of Signature over printed name of

Student authorized person
ID# presented: ID# presented:
Issued by: Issued by:
Contact #: Contact #: