_________________________

Date

AUTHORIZATION LETTER

I, _____________________________________, recipient of Social Pension stipend, of legal age,

(Name of Social Pensioner)
presently under the custody of my child/relative, ___________________________________, in
(Name of custodian)
___________________________________, with contact number of ______________________.
(Complete address)
authorizes my _________________________, ________________________________________
(relationship to beneficiary) (name of authorized Rep)
Who is presently residing in _____________________________________________, to claim
my
(complete address of authorized Rep)
stipend in the amount of _____________________________________ for the
_____________________________________, subsidy from the government due to reason
stated below:
- Bedridden
- Sick
- With physical disability
- Other personal matters
Please specify the reason _______________________________________

That I am fully aware that he/she will affix his/her signature in the payroll for and in my behalf.
Thank you.

______________________________________
(Signature over printed name of beneficiary)

Conformed by:

______________________________________
Signature over printed name of Authorized Representative

Attested by:

______________________________________
Signature over printed name of SC Brgy. Chapter President