Republic of the Philippines

Province of Iloilo
Municipality of Miagao

AUTHORIZATION

This is to authorize _________________________________________________, ____________________, _______ of

First Name, Middle Name, Surname Relationship to beneficiary Age

______________________________________ to claim/receive my Social Pension Stipend for 3rd Quarter 2024 amounting to
Address
Php 3,000.00 due to _____________________________________________.
State the reason for absence

_______________________________________________ _______________________________________
Signature over Printed Name of Beneficiary/Thumbmark Signature over Printed Name of Authorized Representative

Witnessed by:

ANN RHEA M. PANERGAR

Signature over Printed Name of Brgy. Captain
____________________________________________________________________________________________________________

Republic of the Philippines

Province of Iloilo
Municipality of Miagao

AUTHORIZATION

This is to authorize _______________________________________________, ____________________, _______ of

First Name, Middle Name, Surname Relationship to beneficiary Age

______________________________________ to claim/receive my Social Pension Stipend for 3rd Quarter 2024 amounting to
Address
Php 3,000.00 due to _____________________________________________.
State the reason for absence

_______________________________________________ _______________________________________
Signature over Printed Name of Beneficiary/Thumbmark Signature over Printed Name of Authorized Representative

Witnessed by:

ANN RHEA M. PANERGAR

Signature over Printed Name of Brgy. Captain
____________________________________________________________________________________________________________
Republic of the Philippines
Province of Iloilo
Municipality of Miagao

AUTHORIZATION

This is to authorize _______________________________________________, ____________________, _______ of

First Name, Middle Name, Surname Relationship to beneficiary Age

______________________________________ to claim/receive my Social Pension Stipend for 3rd Quarter 2024 amounting to
Address
Php 3,000.00 due to _____________________________________________.
State the reason for absence

_______________________________________________ _______________________________________
Signature over Printed Name of Beneficiary/Thumbmark Signature over Printed Name of Authorized Representative

Witnessed by:

ANN RHEA M. PANERGAR

Signature over Printed Name of Brgy. Captain