Republic of the Philippines

Province of Davao del Norte

CITY OF TAGUM

OFFICE OF THE CITY ACCOUNTANT

BHW / BNS / BSI / CDC / BSW

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 / Payroll 4
2 Obligation Request (OBR) 4
3 Copy of City Ordinance (if applicable ) 1

DISABILITY BENEFITS / MEDICAL ASSISTANCE

4 Medical Certificate / Certificate of Confinement 1
5 Certification issued by CHO / CSWD 1
6 Police Report regarding the alleged accident, if confinement was due to an accident 1
7 Certification from the HRMO 1

DEATH / BURIAL BENEFITS

4 Photocopy of Authenticated Death Certificate 1
5 Affidavit of Claimant 1
6 Photocopy of Marriage Contract (if married) 1
7 Certification issued by CHO / CSWD that the deceased is employed by the CITY and is assigned in his Office
1 at the time of de
8 Certification from the HRMO 1

MATERNAL BENEFITS
4 Certified True Copy of Approved Application for Leave 1
5 Medical Certificate / Certificate of Confinement 1
6 Certified True Copy of Maternity Leave Clearance 1
7 Certification issued by CHO / CSWD 1
8 Length of Service Certificate from HRMO or Service Record 1

RETIREMENT BENEFITS
4 Letter Intent to Mayor 1
5 Certification issued by CHO / CSWD (indicating total number of years in service) 1
6 Certificate of Live Birth 1
7 Certificate of Accreditation 1
8 Copy of City Ordinance 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)