Republic of the Philippines

Province of Surigao Del Norte

City of Surigao
BARANGAY WASHINGTON

OFFICE OF THE SANGGUNIANG KABATAAN

___________________________________________________________________________

AWARD/PRIZE RECEIPT
____________________________________________, has been awarded a prize/award of
(Name)
________________________________________ valued at P__________ by
(Description) (Amount)
Sangguniang Kabataan of Barangay Washington in recognition and participation in the
following event ______________________________on____________________.
(Date)
___________________________________________________________________________

By filling out the information below, I acknowledge receipt of an award or prize from
the Sangguniang Kabataan of Barangay Washington. I understand that if I received a
cumulative value of cash, I will receive a form them. By signing this form, I am attesting
to its accuracy.

Recipient Name _______________________________________

Address ___________________________________________________________

Contact Number ______________________

Recipient Signature _________________________

Authorizing Signature ______________________

Date _______________