CS Form No.

4
Revised 2018

Republic of the Philippines

Department of Education
MIMAROPA Region
Schools Division Office of Romblon
District of San Agustin- Calatrava- Santa Maria
Sto. Niňo Elementary School

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms./Mr. SHAMBELL M. RELANO has assumed the

duties and responsibilities as Administrative Officer II of
San Agustin- Calatrava- Santa Maria District
effective _________________ .

This certification is issued in connection with the issuance of the

appointment of Ms./Mr. SHAMBELL M. RELANO as Administrative Officer II .

Done this ____ day of __________ ________ in ______________ .

MARCIANO M. MERANO
School Head/ Principal

Date: ________________

Attested by:

JESUS LUCKY M. FAIGAO

Administrative Officer V

201 file
Admin
COA
CSC For submission to CSC FO
within 30 days from the
date of assumption of the
appointee