SOP Exhibits

Title:

Exhibit

SOP Number : HR-PR04.A

Exhibit 1 (4 copies)

Republic of the Philippines
NATIONAL FOOD AUTHORITY
General Services Department/
Regional Office _________/ Provincial Office ________

CERTIFICATION

This is to certify that based on available records of this office Mr./Ms. ____________________ __________________
(Name of applicant) (Position/Designation)
has no property or accountabilities (PPE/Supplies and Materials (inventories)/telephone bills/firearms and etc.) of this office as of ______________________.
(Date of Certification)

This certification is issued in connection with Mr./Ms. _______________’s application for CS FORM 7 required for his/her ________________ effective _________________.
(indicate the purpose) (indicate date)

_____________________________________

Department Manager, GS/RM/PM

(

Signatures over printed name

)

Date of Certification: ___________

Please settle/return/transfer the following accountabilities at NFA Cashier/GSD/SSID and attach the certified photocopy of the corresponding Official Receipt/RRP/ICS to facilitate issuance of your clearance.

Statement of Property Accountabilities
Replacement Division Chief/
Particulars Depreciation Amount Cost RAO/PAO

[ ] Property, Plant and Equipment (PPE) ____________ ________ ____________ ______________

________________________

[ ] Supplies and Materials (Inventories) ____________ ______________

________________________

[ ] Landline/Mobile phone bills – (current balance as of ___________) ____________ ______________

________________________

[ ] Unreturned/Lost property/ies (@replacement cost) _____________ ______________

________________________

[ ] Others (please specify) ____________ ______________

________________________

[ ] Armory ____________ ______________

TOTAL

=============

Copy furnished: RAO/PAO

Exhibit 2 (4 copies)

Republic of the Philippines
NATIONAL FOOD AUTHORITY
Security Services and Investigation Department
Regional Office _________/ Provincial Office ________

CERTIFICATION

This is to certify that based on available records of this office Mr./Ms. _________, ______________, has [ ] not been issued [ ] has been cleared from firearms accountability as of
(Position/Designation/Office)
____________ per Property Acknowledgement Receipt No. ______ dated _______.
(Date of Certification)

This certification is issued in connection with Mr./Ms. _____________________’s application for CS FORM 7 required for his/her _______________ effective ________.
(indicate the purpose) (indicate date)

__________________________

Department Manager, SSID/
Regional/Provincial Manager
(Signature over printed name)
Date: _____________

Please settle/return the following Firearms at NFA Cashier/GSD/SSID and attach the certified photocopy of the corresponding Official receipt/RRR/ICS to facilitate issuance of your clearance.

Statement of Firearms Accountability

Please be informed that based on our available records you have the following firearms accountabilities as of _________________.
(Date of Certification)

FIREARMS SPECIFICATIONS : ____________________________
____________________________

ARMORER/SUPPLY OFFICER/PROPERTY CUSTODIAN:

_____________________________
(Signature over printed name)

Exhibit 3 (4 copies)

Republic of the Philippines
NATIONAL FOOD AUTHORITY
Human Resource Management Department
Regional Office _________/ Provincial Office ________

CERTIFICATION

This is to certify that based on available records of this office, Mr./Ms. (name of employee) assigned at (department office) of the National Food Authority has complied with the following requirements necessary for the approval of his/her clearance:

Cleared Not Cleared Division Chief/RAO/PAO

1. Service Contract [ ] [ ] _______________ _____________________

2. Training/Seminar Report [ ] [ ] _______________ _____________________

3. Exit Interview [ ] [ ] _______________ _____________________

4. ID [ ] [ ] _______________ _____________________

5. SALN [ ] [ ] _______________ _____________________

6. Others (please specify) [ ] [ ] _______________ _____________________

____________________

This further certifies that Mr./Ms. __________ has an accrued vacation and sick leave credits of _________ and ___________ respectively, as of _____________.

This certification is issued in connection with Mr./Ms. __________________ application for (indicate purpose and effectivity/inclusive period covered).

______________________________________
Department Manager, HRMD/RM/PM
(Signature over printed name)

Date of Certification: ________________

Instructions:

1. The HRMD-PBU/Administrative Unit shall receive the employee’s request for Certification for whatever purpose (transfer/retirement/resignation/prolonged leave/etc.) the employee is applying for.

2. The HRMD-PBU/Administrative Unit shall prepare the Certification (Exhibit 3) in 4 copies and give it to HRMD-MDD to check the items concerning their division, if the employee is cleared/uncleared.

3. If the Employee has a deficiency/obligation on the items indicated in the certification, the clearing officer must check the box under the “Not Cleared” portion and indicate the deficiency /obligation that the employee must accomplish/satisfy in order to be cleared.

4. The clearing officer must affix his/her signature and date signed.

5. Any item that is not applicable on the purpose of the clearance, (e.g. exit interview, SALN, ID) the clearing officer must indicate “N/A” on the “not cleared” underline portion.

6. Upon signature of this Certification by the Authorized signatory, it must be returned to the HRMD-PBU/Administrative Unit for proper recording, filing and release to concerned employee.

7. This Certification must be issued/released within 10 working days upon receipt of employee’s request and complete document requirements (if any).

MANAGEMENT SERVICE MULTI-PURPOSE COOPERATIVE Statement of Outstanding Loan Balance & Monthly Amortization To: ____________________________________ (Name of employee) This is to inform you that based on available records of this office, you have the following unpaid loans with us as of ______________: LOAN AMOUNT ______________ _______________ ______________ _______________ ______________ _______________ ______________ _______________ Total _ Please settle the above loans with our Cashier/Treasurer and attach the certified photocopy of the corresponding Official Receipt to facilitate issuance of your certification. ___________________________ Date: ________________ Credit & Collection Committee/ Authorized Officer (Signature over Printed Name) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - -- - - Certification This is to certify that based on available records Mr./Ms. ______________ (Name of Employee/Office) has no outstanding accounts with MSMPC. This certification is issued in connection with Mr./Ms.__________’s application for CS FORM 7 required for his/her _______ effective ______. (indicate the purpose) (indicate date) _________________________________________ Date: __________ Credit & Collection Committee/ Authorized Officer (Signature over Printed Name)	NFA MULTI-PURPOSE COOPERATIVE Statement of Outstanding Loan Balance & Monthly Amortization To: ____________________________________ (Name of employee) This is to inform you that based on available records of this office, you have the following unpaid loans with us as of ______________: LOAN AMOUNT ______________ _______________ ______________ _______________ ______________ _______________ ______________ _______________ Total _ Please settle the above loans with our Cashier/Treasurer and attach the certified photocopy of the corresponding Official Receipt to facilitate issuance of your certification. ___________________________ Date: ________________ Credit & Collection Committee/ Authorized Officer (Signature over Printed Name) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - Certification This is to certify that based on available records Mr./Ms. ______________ (Name of Employee/Office) has no outstanding accounts with NFA-MPC. This certification is issued in connection with Mr./Ms.__________’s application for CS FORM 7 required for his/her _______ effective ______. (indicate the purpose) (indicate date) _________________________________________ Date: __________ Credit & Collection Committee/ Authorized Officer (Signature over Printed Name)
NFA – PROVIDENT FUND Statement of Outstanding Loan Balance & Monthly Amortization To: ____________________________________ (Name of employee) This is to inform you that based on available records of this office, you have the following unpaid loans with us as of ______________: LOAN AMOUNT ______________ _______________ ______________ _______________ ______________ _______________ ______________ _______________ Total _ Please settle the above loans with our Cashier/Treasurer and attach the certified photocopy of the corresponding Official Receipt to facilitate issuance of your certification. ___________________________ Date: ________________ Authorized Officer (Signature over Printed Name) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - Certification This is to certify that based on available records Mr./Ms. ______________ (Name of Employee/Office) has no outstanding accounts with Provident Fund. This certification is issued in connection with Mr./Ms.__________’s application for CS FORM 7 required for his/her _______ effective ______. (indicate the purpose) (indicate date) _________________________________________ Date: __________ Authorized Officer (Signature over Printed Name)	NFA EMPLOYEES ASSOCIATION Statement of Outstanding Loan Balance & Monthly Amortization To: ____________________________________ (Name of employee) This is to inform you that based on available records of this office, you have the following unpaid loans with us as of ______________: LOAN AMOUNT ______________ _______________ ______________ _______________ ______________ _______________ ______________ _______________ Total _ Please settle the above loans with our Cashier/Treasurer and attach the certified photocopy of the corresponding Official Receipt to facilitate issuance of your certification. ___________________________ Date: ________________ Authorized Officer (Signature over Printed Name) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Certification This is to certify that based on available records Mr./Ms. ______________ (Name of Employee/Office) has no outstanding accounts with NFAEA. This certification is issued in connection with Mr./Ms.__________’s application for CS FORM 7 required for his/her _______ effective ______. (indicate the purpose) (indicate date) _________________________________________ Date: __________ Authorized Officer (Signature over Printed Name)

Exhibit 5 (4 copies)

Republic of the Philippines
NATIONAL FOOD AUTHORITY
TOLA Unit

CERTIFICATION

This is to certify that based on available records of this office Mr./Ms. _____________________ ________________
(Name of employee) (Position/Designation) __________________ has no stock (grains and empty sacks) accountabilities as of ______________.
(Office/Place of Assignment) (Date of Cut-off)

This certification is issued upon the request of Mr./Ms. ____________________________ of ________________ per fax
(Name of Requesting Official & Designation) (Office address)
message ___________________ as reference for the processing of Mr./Ms. ___________________’s application for CS Form 7, required for his/her ______________________ effective ____________________.
(indicate the purpose if clearance) (indicate date)

____________________________________________
Head, TOLA Unit(C.O.)/Regional Manager/OIC
(Signature over printed name)
Date of Certification: ________________

Note:

Please settle the following accountabilities at NFA Cashier and attach the certified photocopy of the corresponding O

fficial

Receipt to facilitate issuance of your certification. Authorized Officer shall fill up Statement of Stock Accountabilities

(Grains and Empty Sacks) if not applicable write “N/A”

Statement of Stock Accountabilities (Grains and Empty Sacks)

This is to certify that based on available records of this office, Mr./M/ ______________________ , ___

(Position title)

_ designated as _______________ handled stock accountabilities (grain and empty sacks) as of _____________________.

(Date of Cut-off)

Title/Name of Warehouse/ Period Covered	Stock	Volume Handled (nkg)	Shortage/(Overage) nkg/pc	Amount	Balance	Remarks
						Note: indicate
						Reference memo
						nos. and O.R.
						nos. & dates

This statement is issued in connection with Mr./Ms. ____________________________’s application for ________________ CS FORM 7 required for his/her ______________ effective ________________.

(indicate the purpose of clearance) (indicate date)

Certified Correct: Approved:

_______________________ _________________________

Sr. Accounting Specialist Provincial Manager/OIC

(

Signature over printed name)

(

Signature over printed name)

Supporting Document :Service Record

Exhibit 6 (4 copies)

Republic of the Philippines
NATIONAL FOOD AUTHORITY
Accounting Services Department
Regional Office ____/Provincial Office_______

CERTIFICATION

This is to certify that based on available records of this office Mr./Ms. _____________________ __________________
( Name of employee) (Position/Designation/office) has no money accountability (e.g. cash advances, unliquidated TEVs, loans from NFA , COA disallowances and other receivables
(Office/Place of Assignment)
with NFA as of ______________.
(Date of Certification))

This certification is issued in connection with Mr./Ms. ___________________’s application for CS Form 7, required for his/her ______________________ effective ____________________.
(indicate the purpose of clearance) (indicate date)

Statement of Money Accountabilities Per Central Office Books

Account Name

Amount

Clearing Officer

___________________ __________________ _______________________

Statement of Money Accountabilities Per Regional/Provincial Office Books

Month	Place of Assignment	TB Schedules	HOA/FOA	HOCA	COCA/BOCA	Clearing Officer
	Region I
	Region II
	Region III
	Region IV
	Region V
	Region VI
	Region VII
	Region VIII
	Region IX
	Region X
	Region XI
	Region XII
	Region XIII
	Region XIV
	Region XV

Note: Please settle the above accountabilities at NFA Cashier and attach the certified photocopy of the corresponding Official

Receipt to facilitate issuance of your certification. Authorized Officer shall fill up Item I and II prior to Certification.

____________________________________________
Department Manager, ASD/
Regional Accountant/Sr. Accounting Specialist
(Signature over printed name)
Date of Certification: ________________

Supporting Documents:

Approved Certifications from: GSD,SSID,TOLA Unit, HRMD and Provident, NFAEA, NFA-MPC and MSMPC;

Authority to Deduct;

Latest Service Record

Promissory Note, if necessary

Exhibit 7 (4 copies)

Republic of the Philippines
NATIONAL FOOD AUTHORITY
Legal Affairs Department

CERTIFICATION

This is to certify that per available records, Mr./Ms.______________________,
(Name of employee)
_______________________ has
(Position/Designation/Office)

	no pending administrative/criminal/civil case

	a pending administrative and/or pending criminal/civil case (Please state details of the pending cases)

This certification is issued in connection with Mr./Ms. _____________________’s

(check the purpose below)

[ ] application for loan(s), please specify ___________________________

[ ] designation/assignment/reassignment as warehouse supervisor

[ ] CS Form 7 required for his/her

( ) Transfer

( ) Retirement/Resignation

( ) Leave, please specify _________________________

( ) Others, please specify _________________________

[ ] Others, please specify ____________________________

Valid for

six months

from date of issue.

Issued this ___________________ day of ____________________, _______ at

Quezon City, Philippines.

______________________
Department Manager, LAD

(Signature over printed name)

Date of Certification ______

Supporting documents:

Latest Service Record

Exhibit 8

Republic of the Philippines
NATIONAL FOOD AUTHORITY
_________________
Office Branch

_______________________

Date

DEED OF UNDERTAKING

I, ______________________________________, Filipino, of legal age, resident of ___________________________________hereby undertake to pay any unpaid accounts and disallowances that may be established after my CS FORM 7 has been approved.

I fully understand that, in case I fail to pay any unpaid accounts/disallowances, NFA has the option to undertake legal means against me.

________________________

Name of Employee

(Signature over printed name)

_________________________

Position/Department Office

Republic of the Philippines)

_____________________ ) S.S.

Subscribed and sworn to before me this ____ day of __________________, at ____________. Affiant exhibited to me his/her __________ with ID No. __________ as competent evidence of identity.

Notary Public

Exhibit 9

Republic of the Philippines
NATIONAL FOOD AUTHORITY
_________________
Office Branch

_______________________

Date

AUTHORITY TO DEDUCT
(COA Circular 2012-001)

This is to authorize the Accounting Services Department, Claims Division/

Field Office – Accounting Unit to deduct any uncovered/unpaid accounts against my

retirement/terminal leave/separation pay/benefits from NFA.

Account

Amount

______________

TOTAL

=============

______________________________

Name of Employee

(Signature over printed name)

______________________________
Position/Department Office