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PARTNER’S SPECIMEN SIGNATURE FOR COMPLIANCE VERIFICATION FORMS

NAME OF FACILITY: _______________________________________________

FACILITY ADDRESS: _______________________________________________
EMAIL ADDRESS: _______________________________________________

SCHOOL HEAD/PRINCIPAL

NAME : ___________________________________________

CONTACT NO. _____________________

SIGNATURE

_____________________ ______________________ ________________________

INITIAL

_____________________ ______________________ ________________________

AUTHORIZED SIGNATORY/IES:

NAME SIGNATURE INITIAL

1._____________________ _______________ _______________ _______________ _______________

CONTACT NO. _____________________

NAME SIGNATURE INITIAL

2._____________________ _______________ _______________ _______________ _______________

CONTACT NO. _____________________

NAME SIGNATURE INITIAL

3._____________________ _______________ _______________ _______________ _______________

CONTACT NO. _____________________

DSWD Field Office III, DiosdadoMacapagalGovernment Center, Maimpis, City of San Fernando Pampanga, Philippines 2000
Tel: (045) 861 – 2413 ; Telefax: (045) 961 – 2413
Email: fo3@dswd.gov.ph
Website: http://www.dswd.gov.ph