AUTHORIZATION
This is to authorize in my behalf my ________________, ___________________________,
(Relationship to beneficiary) (First Name, Middle Initial, Last Name)
______, of __________________________________to claim/receive my UCT grant amounting to
(Age) (Address of Representative)
THREE THOUSAND SIX HUNDRED PESOS ONLY (PHP3,600.00) due to_______________________.
(State the Reason for the absence)
___________________________________ ___________________________________
Signature Over Printed Name of Beneficiary Signature Over Printed Name of Authorized
Representative
Authorized representative identified and guaranteed to receive the grant.
_________________________________ ____________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO
_____________________________________________________________________________________
To be filled-out only to those who are not related up to 2nd degree of consanguinity
Verified and Guaranteed:
_____________________________________ ______________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO
AUTHORIZATION
This is to authorize in my behalf my ________________, ___________________________,
(Relationship to beneficiary) (First Name, Middle Initial, Last Name)
______, of __________________________________to claim/receive my UCT grant amounting to
(Age) (Address of Representative)
THREE THOUSAND SIX HUNDRED PESOS ONLY (PHP3,600.00) due to_________________________.
(State the Reason for the absence)
___________________________________ ___________________________________
Signature Over Printed Name of Beneficiary Signature Over Printed Name of Authorized
Representative
Authorized representative identified and guaranteed to receive the grant.
_________________________________ ____________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO
_____________________________________________________________________________________
To be filled-out only to those who are not related up to 2nd degree of consanguinity
Verified and Guaranteed:
_____________________________________ ______________________________
Name and Signature of Punong Barangay Name and Signature of C/MSWDO