Date: __________________

RO1-ESD Form 2

EVALUATION SLIP
REQUEST FOR CERTIFICATION/AUTHENTICATION OF ELIGIBILITY

Name: ______________________________________________________________________________________
Email Address: _______________________________________________________
CP No: ________________________

(Below information, to be filled out by FO/ESD personnel only)

From Field Office: ______________ With Online Appointment (O.A.) Without O.A. at RO1/
at RO1 Walk-in
Evaluation of Form and Requirements:
FIELD OFFICE REGIONAL OFFICE 1 (ESD)
Complete/ With Deficiency/Discrepancy Complete/ With Deficiency/Discrepancy
Form/
In Order* Complied* In Order** Complied*
Requirement Remarks/ Remarks/
(check if (Received (check if * (Received
applicable) Recommendation by; Date) applicable) Recommendation
by; Date)

(a) (b) (c) (d) (e) (f) (g)

ERRF/
Declaration
Form (e.g.
Name, P/DOB,
place/date of
exam/eligibility,
date/time
accomplished,
etc.)

1 x 1 pictures
(check quality,
format & quantity)

Identification
Card

Original Cert.
of Eligibility
(for
Authentication)
Application
Fee

Marriage
Certificate (for
women unmarried
during time of
exam)
Authorization/
SPA

ID of
Authorized
Person
Others

Action Action
Officer Officer
Date Date
* for transmittal to RO ** for processing

Number of copies: Remarks of ESD Personnel after Processing

______ Certification of Eligibility (COE)
______ Authenticated COE
 Means of claiming COE/Authenticated COE:
Pickup from RO1 on (date/time): ___________________
Pickup from FO: ____________

For inquiries, please get in touch with ESD at: (072) 700-5626 or esd_cscro1@yahoo.com

Note for CSCFO personnel/action officers:

For complete information & requirements: 1. Put check on all applicable entries in Column "b", and sign at the bottom
of table.
2. Transmit to RO for re-evaluation and processing.
For deficient/lacking info & requirements: 1. Fill out Column "c", and sign at the bottom of table.
2. Upon compliance of noted deficiency/ies, fill out Column "d". (There is no
no need to go back and fill out Column "b" once deficiencies are addressed).
3. Transmit to RO for re-evaluation and processing.