DCARF Ver.

Republic of the Philippines

Province of La Union
MUNICIPALITY OF BACNOTAN

Document Creation and Amendment Request Form

Office: LDRRMO Date of Request: MARCH 28, 2022
Please check appropriate box Title of Document: MHEWS-SELF ASSESSMENT (Early Warning System Self-
Assessment Form
Request for
x Create new document
o Amend document
o Archive document

FOR AMENDMENT
Original Statement in the
Section and Subject Title Proposed Amendment/s Justification
Existing Document

(Use additional sheet/s as necessary)

Note: Attach photocopy of actual pages of existing document that is the subject of request.

Reviewing Party
Name Position Comment Signature

Distribution
Please check appropriate box Please indicate number of copies: (indicate all departments/offices affected)
Distribution Scope
x LGU Bacnotan wide
o Department

Prepared by: Approved by:

ROMEL L. MONTIPALCO GILBERT R. ARCE,

HON. Ed.D.
FRANCISCO ANGELITO L. FONTANILLA
Date: ____________________ Date: ____________________
For Document Controller

Received by: ____________________________________ Date: ______________________

Signature over Printed Name