Republic of the Philippines

OFFICE OF THE PRESIDENT

NATIONAL COMMISSION ON INDIGENOUS PEOPLES
Zamboanga del Norte Provincial Office
Old Provincial Hospital, Lacaya St., Biasong, Dipolog City
email add: ncipdipag@gmail.com

CLAIM FORM
EAP PAMANA

Claim Form No. :______________________________________________________________

Date : December 20, 2022

Name : Lyka Castillon Rivera

Complete Address : San Vicente, Katipunan Zamboanga del Norte
IP Ethno Group : Subanen
School : Jose Rizal Memorial State University - Katipunan
Course & Year: Bachelor of Science in Computer Science
Mobile No. : +639814252623
I hereby attest that the above information is true and correct.

______________________________
EAP PAMANA Grantee
Signature over Printed Name

I have reviewed and validated he information of the above grantee based on

the documents submitted and he/she is eligible to claim the EAP PAMANA
Allowance amounting to P 20,000.00 covering the period_________ Semester of
School Year ________________ pursuant to NCIP CEB Resolution No. 07-63-2017,
series of 2017 and existing approved 2022 EAP PAMANA Master List.
Reviewed and validated by:

_______________________________
EAP Focal Person
Signature over printed name