Republic of the Philippines
Province of Cavite
City of Bacoor
Department of Social Welfare and Development
AUTHORIZATION
The bearer is __________________________, ______, of and residing at
PANGALAN NG KUKUHA EDAD
___________________________________. He/She is my __________________ and I am
KUMPLETONG ADDRESS RELASYON SA PENSIONER
authorizing her/him to receive my Social Pension benefit for the month/s of October
to December 2024 due to ______________________________________________________.
DAHILAN KUNG BAKIT HINDI KAYANG KUMUHA NG PENSIONER
(Printed Name of SP/Signature/Thumbmark)
PANGALAN AT PIMRA NG SENIOR
CITIZEN
______________
(Date)
(Signature of Authorized Representative)
PANGALAN AT PIMRA NG KUKUHA
Witness:
LSWDO/OSCA
SP Form - 05
Republic of the Philippines
Province of Cavite
City of Bacoor
Department of Social Welfare and Development
CERTIFICATION AND REQUEST FOR CORRECTION
TO WHOM IT MAY CONCERN:
This is to certify that Mr./Ms.__________________________________________and
(CORRECTED NAME OF BENEFICIARY) )
Mr./Ms.________________________ is the same person and beneficiary of Social Pension for
Indigent Senior Citizens (SPISC).
This is to further certify that the above-mentioned name was born on
________________instead of _____________, ______ years old from Barangay
__________/__________ Bacoor City, Cavite.
This certification is issued upon the request of the above name person for whatever legal
intent and purpose this may serve.
Issued this __________ day of November 2024.
Certified by:
MS. EMILIANA DR. UGALDE, RSW
City/Municipal Social Welfare and Development Officer
