Document Code

FM-SP-DILG-07-01
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT Rev. No. Eff. Date Page
CITIZEN'S CHARTER SERVICE REQUEST FORM 00 06.15.21 of 2 1

SERVICE TITLE: ISSUANCE OF CERTIFICATE FOR FOREIGN TRAVEL AUTHORITY OF REFERENCE NO. FTA-R9-DUMALINAO-2024-01-23-001
LOCAL GOVERNMENT OFFICIALS AND EMPLOYEES DATE OF REQUEST 23-Jan-23
Name of Applicant: Hon. Junaflor S. Cerilles, RMT,MAGD
ADMINISTRATIVE REQUIREMENTS
Compliance Contact Details:
Basic Documents on All Travel Categories

1. Request Letter (Note: Governors, Vice Governors, Mayors, and Vice

Mayors traveling abroad shall indicate the name of the Vice Mayor
and Highest Ranking Sanggunian Member in their request letter)
OTHER NEEDED INFORMATION, if any:
2. A duly notarized affidavit attesting that no administrative charge or
criminal case has been filed or is pending against the applicant, or
Oath of Undertaking, when the applicant has a pending case; and
Position: MAYOR Region: IX
3. A duly accomplished Clearance from Money and Property
Accountabilities, (CS Form No. 7, Revised 2018) - signed by all
Department Heads, indicating if cleared or not cleared and duly
signed by the LCE
LGU: DUMALINAO, ZDS Destination: Nairobi, Kenya
Additional Documents Per Travel Category
OFFICIAL TRIPS
Duration requested: Feb. 6-11, 2024 Category of travel: Official
1. Endorsement from the following officials depeding on the position
of the applicant:
(a) the Local Chief Executive - if the applicant is a Component City
and Municipal Mayor, Vice Governor, Vice Mayor, Punong Barangay
and LG employees;
(b) the Presiding Officer - if the applicant is a Sangguniang
Panlalawigan Member, Sangguniang Panlungsod and Sangguniang
Bayan Member and Sangguniang employees; and
(c) the Punong Barangay - if the applicant is Sangguniang Barangay
Member and Barangay employees including Sangguniang Kabataan;

SIGNATURE:
2. Invitation Letter from the host country or sponsoring agency;
RECEIVED BY: DATE AND TIME RECEIVED
3. Acceptance letter from CHED, TESDA, LGA or organizer, or donor, if
applicable;

4. Copy or draft of the Memorandum of Agreement or Memorandum

of Understanding between the LGU concerned and the LGU abroad
(travel relating to Sister City or LG Technical Exchange Cooperation),
if applicable.

UNOFFICIAL TRIPS Receiving Officer: ARACELI B. AURE-

MLGOO
1. For Governors, Mayors of Highly Urbanized Cities and
Independent Component Cities, Mayor of Pateros
(a) Duly accomplished Application for Leave (CS Form No. 6,
Revised 2020) (b)
Medical Certificate for medical reasons
ENDORSED TO RESPONSIBLE OFFICER: DATE AND TIME ENDORSED
2. Other Elected Officials (including employees - department heads
and below) when the period of travel extends to more than three (3)
months or during a period of emergency or crisis
(a) Duly approved Application for Leave of absence (CS Form No.
6, Revised 2020) (b)
Medical Certificate for medical reasons

Name/Unit and Designation

REMARKS:

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ACKNOWLEDGEMENT RECEIPT
This is to acknowledge the service/s you have requested: REFERENCE NO.
SERVICE TITLE: Date Received Date of Release in case of
extension

Republic of the Philippines

DEPARMENT OF THE INTERIOR AND LOCAL GOVERNMENT
NAME OF RESPONSIBLE OFFICER/UNIT/DESIGNATION:

OFFICE ADDRESS:
__________________________________________________________________
__________________________________________________________________
REMARKS: __________________________________________________________________