CERTIFICATION

Moved Out Household Member

Date: ________________________

This is to certify that the following household members HAS APPEARED on the SAP DEDUPLICATION NAME
MATCHING of the DSWD as a 4P’s Family Member registered outside the Municipality of Abucay-Bataan and that they are No
LONGER Living on the same house with the Pantawid HH Grantee making them tagged as a MOVED OUT FAMILY MEMBER. The
Following person are currently residing here at BRGY. GABON, ABUCAY-BATAAN.
 PREVIOUS
ADDRESS
In line
with (BRGY, this,
it is BARANGA SAP FIRST LAST MIDDLE BIRTH CONTACT DATE MOVED IN MUNICIPALIT
Y BARCODE NAME NAME NAME DATE NO ABUCAY Y, PROVINCE)

PH-COVID-
03080100
0- MACARAI DELA 24/04/199 910781110
Gabon 00000434 RICHARD G PASION 8 7

PH-COVID-
03080100
0- PANGILINA 19/09/198 997788571
Gabon 00000469 MICHAEL TAYO N 3 3

PH-COVID-
03080100
0- 26/07/197 930520204
Gabon 00000497 JULIET POBLETE BANGCO 7 0

PH-COVID-
03080100
0- BERNARD MACALINA 10/05/196
Gabon 00000550 O CARREON O 3 -

hereby recommended that the above list of family member will be tagged as moved out members.

Certified by:
___________________
Name of Barangay Captain
Signature over printed name
Validated By: Concurred By: Noted By:

SHERWIN V. MAHINAY,RSW OFELIA J. ANDRES,RSW ELENA G. DONES,RSW

Name of Validator C/MSWDO Provincial Link
Signature over Printed Name Signature over Printed Name Signature over Printed Name