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SAP Claim Authorization Form

This is an authorization letter for a Social Amelioration Program (SAP) beneficiary to authorize their [relationship] to claim their SAP assistance of 5,000 pesos. The beneficiary is unable to claim the assistance themselves for two reasons: 1) [reason they can't claim in person] and 2) [reason the authorized representative was chosen]. The beneficiary acknowledges the authorized representative will sign for them in the payroll. The letter is signed by the beneficiary and witnessed by the Barangay Chairperson and attested by the C/MSWDO Assistant.

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Shielany Abad
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3K views2 pages

SAP Claim Authorization Form

This is an authorization letter for a Social Amelioration Program (SAP) beneficiary to authorize their [relationship] to claim their SAP assistance of 5,000 pesos. The beneficiary is unable to claim the assistance themselves for two reasons: 1) [reason they can't claim in person] and 2) [reason the authorized representative was chosen]. The beneficiary acknowledges the authorized representative will sign for them in the payroll. The letter is signed by the beneficiary and witnessed by the Barangay Chairperson and attested by the C/MSWDO Assistant.

Uploaded by

Shielany Abad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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AUTHORIZATION LETTER

I, _____________________________________, recipient of Social Amelioration Program,


(Name of SAP Beneficiary)

a resident of Barangay _____________________.

That I authorize my________________________, _____________________________________,


(relationship to beneficiary) (Name of Authorized rep)

who is presently residing in _________________________________________, to claim my


(complete address of authorized Rep)

SAP Assistance in the amount of 5,000.00 from DSWD due to the reasons stated below:

1. _____________________________________________________________
(rason ngano dili sija makaanha sa payout)

2. _____________________________________________________________
(rason ngano ang claimant ang maoy napili na muclaim sa SAP)

That I am fully aware that he/she will affix his/her signature in the payroll for and in my behalf.

Thank you.

____________________________________
(Signature over printed name of
beneficiary)

Witnessed by:

___________________________________
Signature over printed name of Brgy. Chairperson

Attested by:

___________________________________
Signature over printed name of C/MSWDO

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