2023 CHECKLIST FOR CHECK TURN-OVER SLPA Name/individual: HINIUSANG MAHAYANHON SLP ASSOCIATION Fund Source: GAA (SLP REGULAR 2023) In Charged PDO: ANGELO A. SARSALE tT. No. | Required | Documents (complied? 4 ‘SLPA Grant Acknowledgement Receipt - 2 copies \ Ye 2. Signed Disbursement Voucher (DV)-2 copies Yet 3. Photocopy of Check Ni Na 4 Picture during Check Turnover ee 5 Photocopy of deposit slip ya 6 hotocopy of Passbook reflecting the deposited amount. Yee bet 7 — 7 | 7 Authorization Letter from SLPA/Individual Ne 8 Received copy of Certificate of Accreditation (CSO) \ Ye I | | 9 Pictures of posting of CSO Certificates in conspicuous placed yu 10 sO Tumover (Pete. Pavey cont) 11 Client satisfaction measurement ‘oh PROMOTIVE SERVICES DIVISION Sustainable Livelihood Program FIELD OFFICE CARAGA. eb luck PAGE Loft DSWD Field Oifice Caraga, R. Palma Steet, Buran Cy ‘Website: htop Tel Non. (83) 305-8620 | ry4 DSWD PROMOTI _ jERVICES DIVISION wD Caen sceutbie Lvcined Pept tae eet acta FIELD OFFICE CARAGA SLPA GRANT ACKNOWLEDGEMENT RECEIPT ‘Ako si ELMO C. PERUDEZ, Pangulo ng HINIUSANG MAHAYANHON SLP ASSOCIATION na may SLPA ID No: ay pinapatunayan ang pagtanggap ng aming SLPA ng halagang Php 450,000.00 mula sa DSWD para sa aming mga proyekto na isinumite noong August 11, 2023 para sa mga sumusunod na mga modality ng SLP: Modality ‘Amount SCF Php 450,000.00 MD-STF Php 0.00 CBLAF, Php 0.00 TOTAL Php 450,000.00 Bilang kasapi ng HINIUSANG MAHAYANHON SLP ASSOCIATION, ako at ang mga opisyales at mga miyembro ay taos-pusong tinatanggap ang katapat na tungkulin 0 responsibilidad ng aming natanggap na pinansyal na tulong mula sa DSWD-SLP gaya ng mga sumusunod: |-gamit ng pera na naayon sa nakasaad sa aprubadong Mungkahing Proyekto tion Form; 2. Pagsumite ng “GRANT UTILIZATION REPORT" at mga kaukulang dokumento bilang patunay sa paggamit ng mga perang natanggap mula sa DSWD-SLP: Bilang Presidente ng HINIUSANG MAHAYANHON SLP ASSOCIATION ay sinisiguro ko na bantayan ang mga nakasaad sa CBL na alinsunod sa mga alituntunin ng SLPA at DSWD-SLP.. Bilang pagtanggap sa mga responsibilidad para sa perang natanggap mula sa DSWD-SLP, ako at sampu ng mga saksi ay aming nilalagdaan ang dokumentomg ito ngayong ika-_sa buwan ng, taong PANGALAW AT LAGDA PETSA Tinanggap ni (Presidente) E 10/18/23 Sinaksihan ni (Treasurer) 1018/23 Sinaksihan ni (Auditor) so/1823 Sinaksihan ni (miyembro na hindi opisyal a feed 40/16/23 ‘Sinaksihan ni (Miembro na hindi opisya) 10118723 Sinaksinan ni (C/MSWDO)) so/18/23 Website: iors do eow th Tel Now: (O85) 3034620RSW WY) PROMOTIVE SERVICES DIVISION GA Sustainable Livelihood Program eee eae en rater FIELD OFFICE CARAGA Sinaksinan ni (Miyembro na hind opisya) 9/18/29 ‘Sinaksinan ni (Miyembro na hind opisyal (iy opisyan tora Sinaksian ni (Mlyembro na hind opisyan sonie23 Sinaksinan ni (Miyembro na hind opisya) 7 Sinaksinan ni (Secretary) sovie29 Sinaksiban ni (Vice-President) oo commas anate NA. SAB, soner3 Sinaksinan ni (Miyembro na hin opisyal) a L.soLwia soner23 Sinaksihan ni / (Business Operation Manager : 7 7 RACE M. MARILAN sone Shaksitan ni ow (Canvassing Sub-Commitee) NELIAB-GEROY 01823 Sinaksitan ni (Miyemro na hind! opisya) Cate a ROXAN P. ADO so1823 Sinaksinan ni . (Miembro na hind opisya) sTRELLABSISNAR soe Sinaksinan ni (Review Recommending ‘Sub Committee) so ‘Sinaksihan ni (Nomination&. Election Committee) 10/18/23, ‘Sinaksinan ni (SLP Marketing Focal) 1 AG. 10/18/23 PAGE 2062 = DSWD Field Ofice Crags, RP Sot ution Cy, Puppies N00 o Website: itp wins daw gov ph Tet Now: (OHS) 308-60 aSenet FIELD OFFICE CARAGA DSWD PROMOTIVE SERVICES DIVISION DSWD GRA Qn Niet rogram Sinaksinan ni 2 (Miyembro na hindi opisyal) sovie23 Sinaksinan ni Lubin, Onit eee UWple 7. ORIT sovia3 Sinaksihan ni ee (Miyembro na hind! opisyal) MARIBEU T. FABIOSA 10/1823 Sinaksihan ni Kalan (Miyembro na hindi opisya asap ULSALA to/1823 FQ \ Sinaksihan ni = (Review & Recommending) ROSITA M. SAUVAJAN 10118123 Sinaksinan ni onde (Mi hindi opisyal Mele Niehaceiad MERLITA C. LORONA 10/18/23, Sinaksihan ni (Miyembro na hindi opisyal) JOSEFINE,A. RAMI 1018/23, Sinaksinan ni (Audit & Inspection Sub Committee) ELVIES. SAMONTE 10/18/23, Sinaksinan ai ntabed (Miyembro na hindi opisyal) VICTORIA C. SALVADOR 10/1823 Sinaksinan ni (Cashier) og GENEBETH M.\COMPAY 10/1823 Sinaksihan ni (SLPA WSaloora— Partnership Focal) MARIGHO.D, SALVAJAN 1011823 Sinaksihan ni B.B- sya) (Miyembro na hindi opisyal) a Sinaksihan ni (Bookepper & x Membership Committee) E, ISIMA 10/1823 Sinaksinan ni ie (Miyembro na hindi opisyal) fon (Miyembro na hindi opisyal) i I FAT OTT Ca Fn St Fe apcere opt FIELD OFFICE CARAGA ‘DSWD CPB y ee eae eed Pra SLPA GRANT ACKNOWLEDGEMENT RECEIPT ‘Ako si ELMO C, PERUDEZ, Pangulo ng HINIUSANG MAHAYANHON SLP ASSOCIATION na may SLPA ID No: ay pinapatunayan ang pagtanggap ng aming SLPA rng halagang Php 450,000.00 mula sa DSWD para sa aming mga proyekto na isinumite noong ‘August 11, 2023 para sa mga sumusunod na mga modality ng SLP Modality ‘Amount SCF Php 450,000.00 MD-STF, Php 0.00 CBLAF Php 0.00 TOTAL Php 450,000.00 Bilang kasapi ng HINIUSANG MAHAYANHON SLP ASSOCIATION, ako at ang mga opisyales at mga miyembro ay taos-pusong tinatanggap ang katapat na tungkulin o responsibilidad ng aming natanggap na pinansyal na tulong mula sa DSWD-SLP gaya ng mga sumusunod 1. Tamang pag-gamit ng pera na naayon sa nakasaad sa aprubadong Mungkahing Proyekto at Modality Application Form; 2. Pagsumite ng “GRANT UTILIZATION REPORT" at mga kaukulang dokumento bilang patunay sa paggamit ng mga perang natanggap mula sa DSWD-SLP: Bilang Presidente ng HINIUSANG MAHAYANHON SLP ASSOCIATION ay sinisiguro ko na bantayan ang mga nakasaad sa CBL na alinsunod sa mga alituntunin ng SLPA at DSWD-SLP. Bilang pagtanggap sa mga responsibilidad para sa perang natanggap mula sa DSWD-SLP, ako at ‘sampu ng mga saksi ay aming nilalagdaan ang dokumentomg ito ngayong ika-_ sa buwan ng taong PANGALAN AT LAGDA PETSA Tinanggap ni (Presidente) s/t Sinaksihan ni (Treasurer) 4018723, Sinaksihan ni (Auditor) ron Sinaksihan ni hindi opisyal) (Miyembro na hindi opisyal) nee ‘Sinaksihan ni (Miyembro na hindi opisyal) 19/18/23, Sinaksihan ni (C/MSWDO)) 10/18/23 os ‘DSWD Fra Ofics Caras, Pal Sirs, Hatan Cay, Pippy ROOD ‘Website itn, wre dw aon Tel Now: (O85) 308620pswo w PROMOTIVE SERVICES DIVISION DSWD ch Susan ed ropa totes tot ‘aha FIELD OFFICE CARAGA sinaksnen he (Miyembro na hindi opisyal) IN 10/1812: Shaksinan ay ee ERLINA C. ABANDO 10/18/23, Sinaksinan ri (Miyembro na hind! opisyal) ELSA P. MANTILLA tosera3 Sinaksihan ni Adehava. (Miembro na hindi opisya) b a — ‘Sinaksinan ni (Secretary) so Sinaksinan ni omc cfotrls CHERRY ANN A. SABALO 1018723 acters Bea (Miyembro na hind! opisya) Daisy L. goLMIA sonis23 Sinaksinan ni ! (Business Operation Manager) ea toneps (Canvassing Sub-Committee) NELIAP_GEROY 10/1823 Sinaksinan ni Q- hind opisyal) ee ROXAN P. ADO 101829 Sinakaton 1 Bora. (Miyembro na hindi opisya) ESTRELLA P.BISNAR 10/1823 ‘Sinaksinan ni (Review Recommending S ‘Sub Committee) 10/18/23 Sinaksinan ni Lal (Nomination& Election Committee) B sosee3 Sinaksinan ni a P Marketing Focal ee TERESITA G. R¢ NC 10/18/23 PAGE 2of2 ‘DSWD Frei Ofiee Caraga, Palma Soest Buran Cy Pilipnes 8600 Website: hip oars ded pow ph Tel Nos (04S) 303620DSWD @P20E gy mummemmcsens portent FIELD OFFICE CARAGA Sinaksihan ni > (Miyembro na hindi opisyal) 10/18/23 ‘Sinaksihan ni ~ ‘Sinaksinan ni (Miyembro na hindi opisyal) YN U. SA soneres ‘Sinaksiban ni xT (Review & Recommending) sores Sinaksitan ni (iyembro na hin opisyap -— =a Sinaksinan ni mr (Miyemro na hindi opisyal) oser| Rea RANG 10118123 Sinaksinan ni (Audi Inspection Sub Dm Commitee) ELVIES. soei23 ‘Sinaksihan ni % - (Miyembro na hindi opisyal) wicr . 10/18/23 Sinetsivan (Cashion oxveaf nit Dheay 101 3 Sinaksinan ni (SLPA Salva Partnership Focal) MARICHO D, salyasak 1018/23 Sinaksinan ni pe : PB. (Miyembro na hindi opisya) Depa am ‘Sinaksihan ni (Bookepper & e ‘Membership Committee) Fi t sores ‘Sinaksinan ni Annie, 7mbro na hindi opisyal Wit ee cone ANNIE L. ZAMBON 10/18/23 PAGE Sof? DSWD Fld Ofc Cogs Pas See an Cy, Pine 80 ‘Webi htp wd sp Ted Now: (045) 308-620‘Department of Social Welfare and Development DISBURSEMENT VOUCHER poses | | oschect Ceommeclcnee aba CJoten ene spet FTIN/Employee No, [ORS/BURS No. IHINIUSANG MAHAYANHON SLP ASSOCIATION Lhsess _| initiator: fy. Mahayahay, Kitcharao, Agusan de! Norte Particulars bity | _MFO/PAP Provision of Seed Capital Fund (SCF) to HINIUSANG MAHAYANHON ISLP ASSOCIATION for Hog Fattening project at Brgy. Mahayal kitcharao, Agusan del Norte under SLP GAA 2023, [8._[TAccounting entry ft 1010010000200 Account Title [Acs Code [Debit credit =F ed [c. [certified PE LT casnpratabie Cin to Authority o Debit Account (when applicable), Ops na dacurmants complete and amount claim Broper [Signature Printed Name (GRETCHEN F. 5BCh aepouneant Position pp eeeeeeeenen er Ta aa eerie | fe. | Ichecky ADA No. Poromotive Services Dusion (thorized Representative [ate te] 23+ N- /0499 Signature Pies [official Receipt No. & Date/Other DocumentsDepartment of Social Welfare and Development DISBURSEMENT VOUCHER beies | | Cwoscnet Eeomneriicnet aoa Jones rene et lmase | FTIN/Employee No, [ORS/BURS No. IHINIUSANG MAHAYANHON SLP ASSOCIATION, i a lesen | Brgy. Mahayahay, Kitcharao, Agusan del Norte. eT Provision of Seed Capital Fund (SCF) to HINIUSANG MAHAYANHON: ISLP ASSOCIATION for Hog Fattening project at Brgy. Mahayahay, kitcharao, Agusan del Norte under SLP GAA 2023 Tertihed, Expenses) | -Responsibity | MFO/PAP. SC ay aT Account Title ferent otf _catt pou rere [amo _| ae Cpe documents complete and amount claimed reper 2 ‘Signature, Printed Name Position PSEA. Services Dison efauthoried Representativelig PROMOTIVE SERVICES DIVISION @pswo @B27 YY St eessterne Serenata Senet ren FIELD OFFICE CARAGA. PHOTOCOPY OF CHECK Pace att = TBD TAT OM Cn Pts Sos an CPs OT ap ial tare ‘ZaPROMOTIVE SERVICES DIVISION Sustainable Li FIELD OFFIC DSWD PEIN PICTURE DURING CHECK TURNOVER PAGE Loft DSWDF WePROMOTIVE SERVICES DIVISION Sustainable Livelihood Program FIELD OFFICE CARAGA. DSWD GPE y PHOTOCOPY OF DEPOSIT SLIP PAGE tot DSWD eid Office Caraga R Palin Stet Butuan Cy Website: hipsieww.dswwdgovph Tel Nos. 305-8620DSWD SORE gy ™omme toe ttt ——— FIELD OFFICE CARAGA PHOTOCOPY OF PASSBOOK REFLECTING THE DEPOSITED AMOUNT vaca POTTS Ce a? a @ “Tel Nos: (ORS) 303-8620pswD PROM( _E SERVICES DIVISION CARAGA Sustainable Livelihood Program Semmetstseatten sn yet Teena FIELD OFFICE CARAGA AUTHORIZATION LETTER TO COLLECT THE CHECK October 18, 2023, To: MARI-FLOR A. DOLLAGA-LIBANG Regional Director DSWD Field Office Caraga Butuan City, Agusan del Norte To whom it may concern: Greetings! |, ELMO C. PERUDEZ, hereby authorized Mr.. RENANTE G. ABENDANIO and/or RPMO designated staff to claim the SLP Association Check in the CASH UNIT Section of DSWD FO Caraga for Check Turnover in the Municipality of Kitcharao, Province of Agusan del Norte. Thank you for your consideration. Yours sincerely, ELMO C. PERUDEZ Name and Signature PAGE Loft DEW Fre Ofce Carga, K Pla Stet, tian City Pips 8600 Webaie:ito wire Tat Now 4085) 3088620 a“4 Republic of the Philippines DSWD DSWD-CSO ACRN NO, 82023-4039 Certificate of Accreditation is hereby issued to — a SLP ASSOCIATI with address at purok 8, Brgy. Mahayahay, Kitcharao, Agusan del Norte operating at CARAGA REGION This Certificate of Accreditation shall be valid for three (3) years unless sooner revoked. Issued this 26th day of September 2023 in Butuan City, Philippines. ~ MARI-FLOR ai \GA- LIBANG. Regional Director, Region MII Field ‘Caraga Department of Social Welfare and Devel Seer e es a oo oy, Bective by! Bim2 c- AG - leh aanarn SLE CrestBese PROMOTIVE SERVICES DIVISION DSWD BORE gy musics Sst ter Dr a D OFFICE CARAGA PICTURES OF POSTING OF CSO CERTIFICATES IN CONSPICUOUS PALCES DSWD Fan Os Cage Fate Set Donan CGN BT a?PROMOTIVE SERVICES DIVISION ivelihood Program OFFICE CARAGA @DSWD P22 PICTURE DURING CSO TURNOVERSv: | REV 00| 22 SEP 2023 DATA PRIVACY CONSENT (FOR APPLICANT/ DESIGNATED REPRESENTATIVE OF DSWD - REGULATORY SERVICES) In compliance with the Data Privacy Act (DPA) of 2012, and its Implementing Rules and Regulations (IRR) effective since September 8, 2016, | allow the Department of Social Welfare and Development (DSWD) to enter and store my personal data within the Department's authorized storage system and will only be accessed by the DSWD authorized personnel. The DSWD has instituted appropriate organizational, technical and physical security measures to ensure the protection of personal data. Furthermore, the information collected and stored in the portal shall only be used for the following purposes: 1. Processing and reporting of documents related to the conduct of regulatory activities (e., registration. licensing, accreditation of SWDAs andlor service providers), under certain conditions as required by law. 2. Announcements or promotions of programs, projects, and other activities organized by the Department and its partners. 3. Activities pertaining to establishing relations with DSWD stakeholders. | understand that | am given certain rights under the Data Privacy Act, including the right to object to processing of my data, the right to access my data, the right to correct any inaccurate data, and the right to erasure or blocking of data. For more information on these rights, and for requests to review the Data, to withdraw consent to the use of the Data for any of the purpose stated above, and/or to correct or update the Data, | am to contact the Standards Bureau Data Privacy Compliance Officer at srb@dswd.gov.ph. Signed this day of 2023 at eLmolc. om SLPA President PAGE tof DSWD Freid Office Carapa, R- Palma Sivct, Buruan City, Philippines 8600 oa ‘Website ip wd gun Fel Non: (45) 308-8620 —CLIENT SATISFACTION MEASUREMENT FORM ‘DSWD.OMS.GF-005 | REV 03 | 18 OCT 2022 FIELD OFFICE CARAGA / PROMOTIVE SERVICES DIVISION / SUSTAINABLE LIVELIHOOD PROGRAM PANGALAN NG OPISINA AT DIBISYON (\VAME OF OFFICE/BUREAU AND DIVISION) err auwatwa [rant 2597 FRI ay Cea pease an Das (Birth Date:da/mm/yyyy} (Barangay, Municipality, Province), So aT we = tin seer sts rol on a amos | amen foie ‘ELMO CURATIVO PERUDEZ roy t ‘pital « 5) a EEers el Pha a |SEKTOR (SECTOR): URI NG KLIYENTE (TYPE OF CLIENT): ae aa ee () Manggagawa sa Gobyerne (Government Employee) |( ) Nakatatanda (Senior Citizen) (.) Mga Bata (Children) Pribadong Kompanya 0: anisasy Jusiness or Priv Bunter {)UeagPamipes tong nangangslangan na nasa hstngadat {bated Kempany'oGramisnyon Baer Prine fete eet co ramng | Vout gs ey cckrote Rennes (EE cena |) Taong may Kapansanan () Kababaihang nasa Mahirap na Kalagayan (Women in Diicut Circumstances) |‘) afmianon: 7 (Person with Disabiityies) ( ) Others (Please specify); (.) Empleyade ng DSWD (OSWD Employee) ( ) Others (Please specify) : Sco sn nS Sa aP Evatt | omevon ne Toone A eiwTavans agra Tee onaes pene aner mace oes cnn (RS “Opsyonal (Optional) ANGEW Ke Resale Poo 'WARKAVAN NG BILOG (0 JANG NUMERO PARA SA ANTAS NG IYONG KASIYANAN SA EMPLEYADO NA NAGBIGAY NG GERBISYO aes maaan span Manag Naan on Nesianan na Neanan Luts ain nasanan ‘ey sews "saute ‘ot Sana’ Daatted Testa They Bowne ‘ 3 2 1 |PAPURI © MUNGKAHI SA IKAUUNLAD NG TUMULONG NA EMPLEYADO (Commendation ar Suggestion forthe attending staf) “Opsyanal (Optional Pal Ps haopingare eprom nyo omg pede ang ong ln omunghah faced mea aig seo (85) 305-0620. Page 1 of 2/(Pahina 1)DSWO-QMS-GF-05 /REV 03/18 OCT 2022 MARKAHAN NG TSEK (/) ANG PARAAN NG PAGHINGI NG SERBISYONG KAILANGAN (Please check the modes use in requesting the service) Personal na pumunta se tanggapan (Walk-in) ( )DSWD Facebook Page ( ) DSWD Website C) Pagtawag (Telephone Cal) (Electronic Mal (emal) (Other Websites: (Others; Please specty. 'MARKAHAN NG TSEK (/) ANG ANTAS NG IYONG KASIYAHAN SA SERBISYONG IBINIGAY. [MAAARING PILIIN ANG SALITANG (WA) KUNG HIND! ANGKOP SA SERBISYONG NABANGGIT. [Rate Your Satisfaction Level on te Peformance of the Seve (Please Choose WAI the Indicated Service is Not Appeal) 7 se = wee | cee Set | oe SET] es (Process owner and implementing efice to ent Input the sence name inthis potion) clay dao | atte | Ommersaicedror | ction | hg be : - ee merece ote @/e@|e2lele! © reared ero ee 7 Ramana gs apo FF — Fase a aaerseeacioasse ca CS een Ree eae (Courtesy and Ctarity ) = ak area a Soa eT eee = 7 ia aoantaes = i as Z 1 rg tr mre pea 7 ie ass rae ee Toews c 'MUNGKAHI © REKLAMO SA IKAUUNLAD NG SERBISYO NA NATANGGAP | (Suageston or Complaint to imerove the received Service) | "Opsyenal(Gptenal ‘5A PAMAMAGITAN NG PAGSUSUMITE NITONG CLIENT SATISFACTION MEASUREMENT FORM, PUMAPAYAG KA SA PANGONGOLEKTA, PAGBUO, PAGGAMIT, PAGPROSESO, PAGLIMBAK, AT PAGPAPANATIL NG IYONG PERSONAL NA DATA NG DSWD PARA SA LAYUNING SUKATIN ANG KASIVAHAN NG KLIVENTE SA MGA SERBISYO NG OSWD. (2p nomena cnt atten Meer FO ad ete een pre, oes. Thais Para Kaainaneimpermanoe man yo ag pd ta aye no mana Tagan o anwog aing woes (085) 505-8620)