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CS Form No. 7
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
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Series of 2018
CLEARANCE FORM
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I. PURPOSE
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_______________________
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 Date of Application
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TO:
DSWD-NCR
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I hereby apply for clearance from money, property and work-related accountabilities for
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Purpose:___ Transfer Resignation ____ Other Mode of Separation:
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___ Retirement ____ Leave Please specify:______________________
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Effectivity/Inclusive Period:
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Office of Assignment:
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Position/SG/Step: Name and Signature of Employee
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II. CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
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We hereby certify that this applicant is cleared of work-related accountabilities from the Unit/Office/Department
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Immediate SupervisorHead of Office
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III. CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
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Name of Unit/Office/DepartmentClearedNot ClearedName of Clearing Officer/Official Signature
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1. Administration Sector
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a. Supply and Property Procurement and Management ServiceCHERILYN L. CAUAN
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b. Human Resource Planning and Performance Managemet SectionARA A. BARBER
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c.General ICT ResourcesJERVIN R. REGIO
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d. Agency-Accredited Union CooperativeEVANGELINA G. LAWAS
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WEMPC Chairperson
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ALAN A. BALABA
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SWEAP NCR Chapter, President
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2. Library
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a. Legal Office LibraryN/A
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b.Library ServicesN/A
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3. Finance and Assets Management
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a. Financial ServicesMELBA A. VILLASEÑOR
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b.Transaction, Processing and Billing ServicesMILAGROS U. BUMANLAG
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c. Payroll and Remittance Services REMILYN G. ALOTA
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4. Professional and Institutional Development
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a. Scholarship ServicesOLGA P. SAN PEDRO
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IV. CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE
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a. Internal Affairs Office/Legal Affairs Office ATTY. JAIME D. JURADO II
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with pending administrative case
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with ongoing investigation (no formal charge yet)
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V. CERTIFICATION
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I hereby certify that this employee is cleared of work-related, money and property accountabilities from this agency. This certification includes no pending administrative case from this agency.
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MICHAEL JOSEPH J. LORICO
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 Regional Director, DSWD-NCR Page 1 of 2
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INSTRUCTIONS:
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1. Emploees wo are retiring, being separated, transferring to other agencies, leaving the Philippines and gouing on maternity leave of absence shall prepare this form in quadruplets.
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2. This clearance should be duly accomplished before paying the last salary or any money due the employees. (Specify which type of clearance: maternity leave, retirement, transfer, etc.)
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3. If the employees are cleared from a unit/office/department, the clearing/authorized official may attach to this clearance the pertinent document/s that shall prove that the employees are cleared of any obligation or accountability from their office, if any, and tick the box under the"Cleared" column before affixing their signatures.
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4. If the employees appear to have uncleared accountability/ies from a unit/office/department, the clearing/authorized official shall attach to this clearance the pertinent document/s that shall prove that the employees have remaining obligation or accountability from their office further indicating the necessary actions/s that the employee must satisfy in order to be cleared, tick the box under the "Uncleared" column. The clearing/authorized official must only sign this clearance correponding to their name once the employee have complied the necessary requirements and cleared of all the obligation/s and accountability/ies from their office. They must also tick the box under the"Cleared" column.
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5. The HRMO shall dustribute copies of approved clearance as follows: original to the employee; duplicate to be attached to the payroll or voucher; triplicate to human resource unit file; and fourth copy to accounting/auditing office.
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6. Processing of clearance certificate shall follow the order of number indicated.
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Page 2 of 2
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