Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

DILG-NAPOLCOM Center, EDSA cor. Quezon Ave., Quezon City
Telephone Number (02) 925-1137

BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM

for the Year __________

CERTIFICATION OF TRUTH, ACCURACY, AND COMPLETENESS

The undersigned certify under penalty of law, based on information and belief formed after reasonable inquiry, the
statements and information contained in this document are true, accurate, and complete.

KENETH C. ORBELLO GERARD C. AGUSTIN

Signature over Printed Name of Chair of Committee on Advocacy Signature over Printed Name of Chair of Committee on Operations
Date signed: _________________ Date signed: _________________

MARCELINO I. BARROGA
Signature over Printed Name of Punong Barangay / BADAC Chairperson
Date signed: _________________

Noted by:

Signature over Printed Name of City/Municipal LGOO or City Director Signature over Printed Name of City/Municipal Mayor
Date signed: ________________ Date signed: _______________