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Clearance Form - Regional Office
HLURB regional field office clearance form
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: HLURB.RFO.0002.01
Republic of the Philippines
Office of the President
Housing and Urban Development Coordinating Council
HOUSING AND LAND USE REGULATORY BOARD
National Capital Region Field Office
CLEARANCE
Date: __________________
Region / Division: __________________
Name of Employee Requesting Clearance:
Position:
Salary:
P__________ per month
Purpose: (Retirement, Resignation, etc.)
Effectivity Date:
Signature:
This certifies that the above-named employee is cleared
from money, property and/or other accountabilities by this Board
ADMIN AND FINANCE DIVISION:
______________________________________
Cashier
Date Signed: _______________
______________________________________
Immediate Supervisor where assigned
Date Signed: _______________
______________________________________
Accountant
Date Signed: _______________
______________________________________
Supervising Commissioner
Date Signed: _______________
______________________________________
Property Officer
Date Signed: _______________
Last day of Service _______________________
Total Leave Credits Earned ________________
As of __________________________________
_______________________________________
Chief Administrative Officer
Date Signed: _______________
RECORDS AND INFORMATION DIVISION:
______________________________________
Records Officer
Date Signed: _______________
Date of Clearance:
ADJUDICATION DIVISION:
Pending Admin. Case as per Records:
______________________________________
______________________________________
______________________________________
Head
Date Signed: _______________
Other Services:
______________________________________
Chief Operating Officer, Provident Fund
Date Signed: _______________
______________________________________
General Manager, Multi-Purpose Cooperative
Date Signed: _______________
APPROVED:
DIR. ALFREDO GIL M. TAN II
Regional Officer
HLURB Bldg. Kalayaan Avenue corner Mayaman Street, Diliman, Quezon City
www.hlurb.gov.ph
