CS Form No.

7
Series of 2017
Series of 2017
DEVELOPMENT ACADEMY OF THE PHILIPPINES
CLEARANCE FORM
(Instructions at the back)

I PURPOSE

05 SEPTEMBER 2022
Date of Application
TO: Development Academy of the Philippines
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: __________________________
Effectivity/Inclusive Period: __________________________________________________________

Office of Assignment: ___ OFFICE OF THE PRESIDENT

ATTY. REMUS ROMANO REYES
Position/SG/Step: _ PROJECT OFFICER II Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.

_______________________________ ATTY. ENGELBERT C. CARONAN JR.,MNSA

Immediate Supervisor Head of Office
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Name of Unit/Office/Department Cleared Not Cleared Name of Clearing Officer/Official Signature
1. Administration Sector

a. Supply and Property Procurement and Management Services RODEL DV. CASTILLO

b. Human Resource Welfare & Assistance RICHA S. TIBO

c. Agency-accredited Union/Cooperative(DPMPC) CHRISTIAN S. EPARWA

MA. THERESA O. JAVIER

d. Library

JOMAR A. PASTRANA
e. ICTD

CHEERY ANNE D. BECERIL

f. Clinic

g Central Documentation &Records Division (CDRD) MONINA AGRIFINA R. DE ARMAS

2. Finance and Assets Management

a. Financial Services ANATALIA SD. BARAWIDAN

b. Transaction, Processing & Billing Services ANATALIA SD. BARAWIDAN

c. Payroll & Remittance Services FILI[INO FRANCISCO P. GOMEZ

3. Professional and Institutional Development

a. Scholarship Services MARIETTA Q. UMBAY

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Internal Affairs Office/Legal Affairs Office ATTY. HEATHER EZRA C. ANNANG

with pending administrative case
with ongoing investigation (no formal charge yet)

V CERTIFICATION
This is to certify that has no pending administrative case with the Academy pursuant to Letter of

Instruction No.14-A. Further, this is to certify that has been cleared of money, property and document accountabilities.

This certification is being issued for whatever legal purpose it may serve.

ATTY. ENGELBERT C. CARONAN, JR., MNSA

President and CEO

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INSTRUCTIONS:

1. Employees who are retiring, being separated, transferring to other agencies, leaving the
Philippines and going on maternity leave of absence shall prepare this form in quadruplicate.

2. This clearance should be duly accomplished before paying the last salary or any money due the
employees. (Specify which type of clearance: maternity leave, retirement, transfer, etc.)

3. If the employees are cleared from a unit/office/department, the clearing/authorized official may
attach to this clearance the pertinent document/s that shall prove that the employees are cleared of
any obligation or accountability from their office, if any, and tick the box under the "Cleared" column
before affixing their signatures.

4. If the employees appear to have uncleared accountability/ies from a unit/office/department, the

clearing/authorized official shall attach to this clearance the pertinent document/s that shall prove
that the employees have remaining obligation or accountability from their office further indicating
the necessary action/s that the employee must satisfy in order to be cleared, and tick the box under
the "Uncleared" column. The clearing/authorized official must only sign this clearance
corresponding to their name once the employee have complied the necessary requirements and
cleared of all the obligation/s and accountability/ies from their office. They must also tick the box
under the "Cleared" column.

5. The HRMO shall distribute copies of approved clearance as follows: original to the employee;
duplicate to be attached to the payroll or voucher; triplicate to human resource unit file; and fourth
copy to accounting/auditing office.

6. Processing of clearance certificate shall follow the order of number indicated.

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