CS Form No.

4
Series of 2017

Republic of the Philippines

__(Name of Agency)__

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms/Mr. ______________________ has assumed

the duties and responsibilities as ________________________ of
_____________________________ effective _________________.

This certification is issued in connection with the issuance of the

appointment of Ms/Mr ________________ as ________________________.

Done this ____ day of __________ ________ in ______________.

________________________
Head of Office/Department/Unit

Date: ________________

Attested by:

________________________
Highest Ranking HRMO

201 file
Admin
COA
CSC For submission to CSCFO
within 30 days from the
date of assumption of the
appointee