Name of Project: TUPAD OSEC-FMS Form No.

4
DOLE Regional Office:
Province: AGUSAN DEL NORTE
City:: CABADBARAN
Barangay: 4 - PERPETUAL SUCCOR

LIST OF BENEFICIARIES

Interested If yes
Name of Beneficiary Address2
E-payment/Bank for skills Indicate skills
Dependent6 (Name of
Birthdate 1
Type of ID Account no. training (Y- needed
Type of Civil Beneficiary of the
No. (e.g. SSS, Voter's ID Number Contact no. (Indicate the type Occupation Sex4 Age Yes N-No
Extension City/ Beneficiary3 Status5 Micro-insurance
First Name Middle Name Last Name (YYYY/MM/DD) Barangay Province ID) of account and no.
Name Municipality Holder)
as applicable)

1 JOCY ALEGADO OPEÑA Nov.. 4, 1972 4 Cabadbaran Agusan del Norte BIR 291-469-778000 09427930017 N/A N/A N/A F widow 48 Necko A. Opeña No
2 ANALY ALEGADO JACINTO Feb. 11, 1979 4 Cabadbaran Agusan del Norte voters 0203-0015B 09093749730 N/A N/A N/A F married 41 Edward Jacinto No
3 JOEL MAPANO DUMANGAS Feb. 26, 1965 4 Cabadbaran Agusan del Norte PhilHealth 18-200334140-3 09464449138 N/A N/A N/A M widow 55 Angelica Dumangas No
4 JERSON MORALES Octo. 19, 1977 4 Cabadbaran Agusan del Norte PhilHealth 18-250728792-2 09463239257 N/A N/A N/A M single 23 Ludivina Morales No
5 CRISTIAN MARK FELIMINIANO BULADO Jan. 7, 2000 4 Cabadbaran Agusan del Norte School I.D 2016-0693 09102190616 N/A N/A N/A M single 20 Rosalie Bulado No
6 RONNEL DAGANI 15-May-98 4 Cabadbaran Agusan del Norte N/A N/A N/A M single 22 Robin Dagani No
7 MERIJEN BAGUIO IIBAY Aug. 8, 1986 4 Cabadbaran Agusan del Norte PhilHealth 18-201046785-4 09486098881 N/A N/A N/A F married 34 Nelson Ibay No
8 CHERISH ANN ALABA CALIPUS Oct. 31, 1993 4 Cabadbaran Agusan del Norte PhilHealth 18-201010739-4 09096363903 N/A N/A N/A F single 27 Adonis Salingay No
9 EDGAR MNDOZA CABAÑERO 12-Jun-63 4 Cabadbaran Agusan del Norte PhilHealth 18-200334798-3 N/A N/A N/A M marride 57 Edgar Cabañero Jr. No
10 FELMAR SALON ANTIGA Aug. 29, 1999 4 Cabadbaran Agusan del Norte Driver's Licence K14-18-005203 N/A N/A N/A M single 21 Federico Antiga Jr. No

I hereby certify that the above list of beneficiaries are displaced marginalized workers, underemployed or self-employed workers that have lost their livelihood or whose earnings were affected due to Enhanced Community Quarantine.

Further, I certify that they were verified to have not received cash assistance from the DSWD under the Assistance to Individuals in Crisis Situation (AICS) and the Enhanced Pantawid Pamilyang Pilipino Program (4Ps), DA's cash assistance for rice farmers, and DOF's Small Business Wage Subsidy Program; and that the total amount of assistance received by the household of each beneficiary from
various social amelioration programs shall not exceed P5,000.00 - 8,000.00 (amount ceiling varies across regions), as prescribed by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID).

QF-TUPAD-013
Prepared and Certified true and Correct by: Revision no: 00
Date Issued: 11/4/2020

LGU or Authorized representative