Dswd-As-Gf-075 - Rev 02 - Request For DSWD Dormitory Accomodation

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ADMINISTRATIVE SERVICE

GENERAL ADMINISTRATION AND


SUPPORT SERVICES GROUP
DSWD-AS-GF-075 | REV 02 | 05 JAN 2023

CONTROL NUMBER: _____________________


REQUEST FOR DSWD DORMITORY ACCOMMODATION
(Note: Request should be made at least three (3) days before the date of actual use)

Date: ______________

Name of Requesting Party : ___________________________________________________

Office : ___________________________________________________

Contact Number : ___________________________________________________

Purpose : ___________________________________________________

Date and Time of Check-in : ___________________________________________________

Date and Time of Check-out : ___________________________________________________

Head of Requesting Office /


Authorized Representative
___________________________________________________________________________________

DSWD Dormitory Room Rates

DSWD Officials/Employees (P300/day)

Non-DSWD Government Personnel (P500/day)

Mode of Payment

To be paid by the Guests/Participants To be paid by the Sponsoring Agency

I promise to pay for the bill for the use of dormitory. I hereby certify that the payment for the use of
dormitory shall be paid by this office.

_______________________ _________________________
Guest Head of Office

Approved/Disapproved:

ATTY. KARINA ANTONETTE A. AGUDO, CESE


Director IV, Administrative Service

By submitting this Reservation Form, you consent to the collection, generation, use, processing, storage and
retention of your personal data by the DSWD for the intended purpose of reserving a room at the CO/FO Dormitory.

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DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 TO 07 Telefax: (632) 8 921-8191

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