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DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
CITIZEN'S CHARTER SERVICE REQUEST FORM
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SERVICE TITLE: ISSUANCE OF CERTIFICATE FOR FOREIGN TRAVEL AUTHORITY OF LOCAL GOVERNMENT OFFICIALS AND EMPLOYEESREFERENCE NO.
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DATE OF REQUEST
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Name of Applicant:
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ADMINISTRATIVE REQUIREMENTS
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ComplianceContact Details:
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Basic Documents on All Travel Categories
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1. Request Letter (Note: Governors, Vice Governors, Mayors, and Vice Mayors traveling abroad shall indicate the name of the Highest Ranking Sanggunian Member in their request letter)OTHER NEEDED INFORMATION, if any:
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2. A duly notarized affidavit attesting that no administrative charge or criminal case has been filed or is pending against the applicant, or Oath of Undertaking, when the applicant has a pending case; and Position:Region:
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3. A duly accomplished Clearance from Money and Property Accountabilities, (CS Form No. 7, Revised 2018) - signed by all Department Heads, indicating if cleared or not cleared and duly signed by the LCELGU:Destination:
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4. Travel Authorization (or Travel Order or Endorsement) from the Local Chief Executive pursuant to Section 6, OP MC No. 35, Series of 2017
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Additional Documents Per Travel CategoryDuration requested:Category of travel:
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OFFICIAL TRIPS
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2. Invitation Letter from the host country or sponsoring agency;
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3. Acceptance letter from CHED, TESDA, LGA or organizer, or donor, if applicable;SIGNATURE:
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4. Copy or draft of the Memorandum of Agreement or Memorandum of Understanding between the LGU concerned and the LGU abroad (travel relating to Sister City or LG Technical Exchange Cooperation), if applicable.
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RECEIVED BY:DATE AND TIME RECEIVED
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UNOFFICIAL TRIPSReceiving Officer
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2. For Governors, Mayors of Highly Urbanized Cities and Independent Component Cities, Mayor of Pateros (a) Duly accomplished Application for Leave (CS Form No. 6, Revised 2020) (b) Medical Certificate for medical reasonsENDORSED TO RESPONSIBLE OFFICER:DATE AND TIME ENDORSED
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3. Other Elected Officials (including employees - department heads and below) when the period of travel extends to more than three (3) months or during a period of emergency or crisis (a) Duly approved Application for Leave of absence (CS Form No. 6, Revised 2020) (b) Medical Certificate for medical reasons
Name/Unit and Designation
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REMARKS:
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ACKNOWLEDGEMENT RECEIPT
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This is to acknowledge the service/s you have requested:
REFERENCE NO.
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SERVICE TITLE:Date ReceivedDate of Release in case of extension



Republic of the Philippines
DEPARMENT OF THE INTERIOR AND LOCAL GOVERNMENT

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NAME OF RESPONSIBLE OFFICER/UNIT/DESIGNATION:
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OFFICE ADDRESS: ______________________________________________________________________________________________________________________________________________________________________________________________________
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REMARKS:
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