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Citizens Charter Service Request Form

This document is a citizen's charter service request form for the Department of the Interior and Local Government. The form collects information about the client and organization, required documents, contact details, and signature for a requested service. It also documents receipt and acknowledgment of the request including expected and actual release dates.

Uploaded by

Ruby Joy Galamay Bugtong
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
103 views

Citizens Charter Service Request Form

This document is a citizen's charter service request form for the Department of the Interior and Local Government. The form collects information about the client and organization, required documents, contact details, and signature for a requested service. It also documents receipt and acknowledgment of the request including expected and actual release dates.

Uploaded by

Ruby Joy Galamay Bugtong
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

CITIZEN'S CHARTER SERVICE REQUEST FORM


SERVICE TITLE Identification no.

NAME OF CLIENT:

NAME OF ORGANIZATION:
DOCUMENTARY REQUIREMENTS Kindly Check the documents needed:

1
2 CONTACT DETAILS:
3
4
5 SIGNATURE:
6
7
8 RECEIVED BY: DATE AND TIME RECEIVED:

REMARK/S: Receiving Officer

ENDORSED TO RESPONSIBLE OFFICER: DATE AND TIME ENDORSED

Name/ Unit and Designation

ACKNOWLEDGEMENT RECEIPT
This is to acknowledge the service/s you have requested: IDENTIFICATION NO:

Expected date of Date of release in


SERVICE TITLE: Date Received
Release case of extension

NAME OF RESPONSIBLE OFFICER/UNIT/DESIGNATION: CONTACT DETAILS: Republic of the Philippines


DEPARMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF THE ____________________________
_________________________________________
REMARKS: __________________________________________
__________________________________________

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