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Clearance Form

AFAB form for clearance

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CLEARANCE FORM
Instructions: Accomplish in three (3) copies for CSD, PSSD, and for the guard on duty at the final exit point.

Pesonal Information
Name & Signature (Last, First, & Middle Name)

Landlord's Name & Signature (Last, First, & Middle Name)

Date today (mm/dd/yyyy)

Date intended to move the
item/s (mm/dd/yyyy)

Present Address
Block No. , Building, Street
Barangay
Municipality
Address where the items will be transferred (o check the box if same as above)
Block No. , Building, Street

Barangay

Province

Municipality

Province

Select Transfer Mode 
o BRING IN to the FAB
o BRING OUT from the FAB

Item Inventory (attach additional sheet(s) if necessary)
Number

Quantity

Description

Unit

1
2
3
4
5
6
7
8
9
10
Clearances
Barangay Malaya/Maligaya (if residing in apartment units, Baclain/KKK, etc.) Finance Department (FD)
Dormitory Supervisor (if residing in AFAB Dormitories)
Name and Signature

Date

Name and Signature

Date

Name and Signature

Date

Freeport Facilities Department/Infrastructure Maintenance Division (FFD) TransCo

Name and Signature

Date

Community Services Department (CSD)

Name and Signature

Public Safety and Security Department (PSSD)

Date

Name and Signature

Date

Processing and Approval
Processed and Evaluated by

Recommending Approval

DONIA G. ALONZO
Name, Designation, and Signature

Division Manager A, FAB Residents Division, CSD
CSD-FRD-FM-005 rev 000 - Clearance Form
 
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