ABCDEFGHIJKLMNOPQRSTUVWXYZ
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CS Form No. 7
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Series of 2017
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Department of the Interior and Local Government
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Provincial Office
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DRRM Complex, Alibagu, City of Ilagan, Isabela
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CLEARANCE FORM
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(Instructions at the back)
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I
PURPOSE
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Date of Application: January 03, 2023
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TO:
_______________
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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: January 03, 2023
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Office of Assignment: CAUAYAN CITY, ISABELA
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JUN EVA D. PAGUIGAN
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 Position/SG/Step:SG 13Name 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 this Unit/Office/Dept.
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RICARTE M. CASTROENGR. CORAZON D. TORIBIO, CESO V
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Immediate SupervisorHead of Agency
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III
CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
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Name of Unit/Office/DepartmentClearedNot ClearedName of Clearing Officer/OfficialSignature
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1.
Administration Sector
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a.Supply and Property Procurement and Management Services
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b.Human Resource Welfare & Assistance
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c.Agency-accredited Union/Cooperative
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2.
Library
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a.
Legal Office Library
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b.
Library Services
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3.
Finance and Assets Management
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a.Financial Services
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b.Transaction, Processing & Billing Services
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c.Payroll & Remittance Services
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4.
Professional and Institutional Development
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a.Scholarship Services
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IV
CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
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a.Internal Affairs Office/Legal Affairs Office
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with pending administrative case
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with ongoing investigation (no formal charge yet)
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V
C E R T I F I C A T I O N
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ENGR. CORAZON D. TORIBIO, CESO V
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 Provincial Director
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