CS Form No.

4
Revised 2018

Republic of the Philippines

DepEd - Division of Pampanga

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms./Mr. _____________________________has

assumed the duties and responsibilities as ________________ of
_______________________________________effective________________

This certification is issued in connection with the issuance of the

appointment of
Ms./Mr.___________________________as______________________

Done this____day of __ _____in______________.

________________________
Head of Office/Department/Unit

Date: Click here to enter a date.

Attested by:

DEXTER E. PANGILINAN
ADMINISTRATIVE OFFICER IV
________________________
HRMO

201 file
Admin
COA
CSC For submission to CSCFO
within 30 days from the
date of assumption of the
appointee