DISTRIBUTION PAYROLL

Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________

I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

DEPS GOODS
Male Female DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

DEPS GOODS
Male Female DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

DEPS GOODS
Male Female DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

DEPS GOODS
Male Female DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.
 NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE
DEPS GOODS
Male Female DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

 Male Female DEPS GOODS
DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

 Male Female DEPS GOODS
DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

 Male Female DEPS GOODS
DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO

DISTRIBUTION PAYROLL
Place of Distribution__________________________ Date________________________ Kind of Disaster ______________________
I HEREBY CERTIFY to have received from PSWDO, Cotabato Province the following goods opposite my name.

NO. NAME OF CLIENT SEX ADDRESS NO. OF SERIES OF SIGNARURE

 Male Female DEPS GOODS
DISTRIBUTED
1 10 KILOS
2 10 KILOS
3 10 KILOS
4 10 KILOS
5 10 KILOS
6 10 KILOS
7 10 KILOS
8 10 KILOS
9 10 KILOS
10 10 KILOS
11 10 KILOS
12 10 KILOS
13 10 KILOS
14 10 KILOS
15 10 KILOS
16 10 KILOS
17 10 KILOS
18 10 KILOS
19 10 KILOS
20 10 KILOS
I HEREBY under oath that according to the records of the office, the persons whose names appear above are really needy clients/or victims of
calamity and said persons are qualified for such assistance.
Submitted by: __________________________ Witness: __________________________ Certified by:__________________________
MSWDO Brgy. Captain/Representative PSWDO