Republic of the Philippines

Province of Davao del Norte

CITY OF TAGUM

OFFICE OF THE CITY ACCOUNTANT

CENTENARIAN / SOLO PARENT ASSISTANCE

Please observe proper
NAME: _______________________________________________________________ sequence of documents and
Doc. No.: __________________________ Tracking No.: _____________ the required number of
copies.

General Requirements: No. of copies

1 Disbursement Voucher 4
2 OBR 4
3 Certificate of Eligibility 1

CENTENARIAN ASSISTANCE
Additional Requirements:
4 Birth Certificate of Applicant 1
5 Birth Certificate of Brother/ Sister/ Child 1
6 Baptismal Certificate of Applicant 1
7 Marriage Certificate of Applicant 1
8 Records of Old School/ Employment (if available ) 1
9 Brief write-up of the life of the Applicant 1
10 Proof that the Applicant (nominee) is alive 1
11 Certification from the Barangay Captain 1

SOLO PARENT ASSISTANCE (Financial - for women only)

Additional Requirements:
4 Original Copy of Medical Prescription 1
5 Medical Certificate/ Cerificate of Confinement (if Ceasarean Operation) 1
6 Certification that the parent gave birth for the first time in a government hospital or government Paanak
1 center
7 Certification for Philhealth/Non-Philhealth membership 1
8 Certificate of Indigency 1

Prepared by: Reviewed/ Pre-audited by: (For Accounting only)

Requesting Office: ____________________________ Name: ________________________ Date Pre-audited:

Name of Representative: _______________________ Signature: _____________________ _______________
Signature: ___________________________________
Contact Number (mobile): ______________________ Remarks: For Payable/Certify For Return

Additional Note or Remarks: (For Accounting only)