Clearance Form - Regional Office

HLURB regional field office clearance form

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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