Republic of the Philippines

DEPARTMENT OF AGRICULTURE
Regional Field Office No. VII
Office of the Regional Executive Director
DA-RFO 7 Complex, Highway Maguikay, Mandaue City 6014, Cebu
Tel. Nos. (032) 268-5187 / 238-2163; Fax No. (032) 268-3063 email: redsoffice7@gmail.com

AUTHORIZATION

I, _______________________is authorizing Mr. /Ms./Mrs._________________________who is

my _______________________ to claim the fertilizer to me due to ______________________.

Sincerely yours,

_____________________________
Name and Signature of Farmer- Beneficiary

Certified by:

______________________________
DA-RFO 7 Personnel

Republic of the Philippines

DEPARTMENT OF AGRICULTURE
Regional Field Office No. VII
Office of the Regional Executive Director
DA-RFO 7 Complex, Highway Maguikay, Mandaue City 6014, Cebu
Tel. Nos. (032) 268-5187 / 238-2163; Fax No. (032) 268-3063 email: redsoffice7@gmail.com

AUTHORIZATION

I, _______________________is authorizing Mr. /Ms./Mrs._________________________who is

my _______________________ to claim the fertilizer to me due to ______________________.

Sincerely yours,

_____________________________
Name and Signature of Farmer- Beneficiary

Certified by:

______________________________
DA-RFO 7 Personnel
 Republic of the Philippines
DEPARTMENT OF AGRICULTURE
Regional Field Office No. VII
Office of the Regional Executive Director
DA-RFO 7 Complex, Highway Maguikay, Mandaue City 6014, Cebu
Tel. Nos. (032) 268-5187 / 238-2163; Fax No. (032) 268-3063 email: redsoffice7@gmail.com

ANNEX L WAIVER
WAIVER, RELEASE AND QUIT CLAIM

Ako si, ___________________________________ nasa hustong gulang, Pilipino,

nakatira sa___________________________________________________,matapos
makapanumpa ng naaayon sa batas ay nagsasaad ng mga sumusunod:

Na aking ipinapahayag na ako ay isang farmer-beneficiary ng National Rice

Program - Fertilizer Discount Voucher Support to Rice Farmers mula sa
Department of Agriculture (DA);

Na sa pamamagitan nito. ako ay may karapatan na makatanggap ng voucher mula

sa DA na may kabuuang halaga na_________________________(PhP____________);

Na sa pamamagitan nito ay isinusuko ko ang lahat ng karapatan at interes na kunin

ang nasabing fertilizer discount voucher;

Na aking isinasagawa ang waiver na ito, nang malaya at kusang-loob upang

patunayan ang mga naunang pahayag para sa anumang legal na layunin na
maaaring ihatid nito;

Na aking ipinapahayag na wala na akong anumang habol laban sa DA o sa khit

sinumang tao na konektado sa pangangasiwa at operasyon ng implementasyon ng
programa at magpakailanman na palayain ang DA mula sa anuman at lahat ng
pananagutan.

________________________________________
(Pangalan at Pirrna/Fingerprint ng Farmer)