Republika ng Pilipinas

Office Address: National Government Center EDSA, Diliman, Quezon City, Philippines

Telefax No. (632) 928-9343 TIN No. 000-916^15

Telephone Nos.: (02) 929-6071 to 78 Website: www.nia.gov.ph

M C N o ^ ^ s . 2018

MEMORANDUM CIRCULAR

TO : THE SENIOR DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATORS, REGIONAL / DEPARTMENT / PROJECT MANAGERS, DIVISION/ IRRIGATION MANAGEMENT OFFICE MANAGERS AND ALL OTHERS CONCERN

SUBJECT : CS FORM NO. 7, SERIES OF 2017 (CLEARANCE)

Pursuant to CSC Memorandum Circular No. 24, s. 2017 "2017 Omnibus Rules on Appointments and Other Human Resource Actions", Section 6.d., provides that in case of transfer, promotion [from one department/agency to another department/agency) and reemployment, clearance from money, property and work-related accountabilities from the appointee's former office is required [CS Form No. 7, Series of 2017).

The attached clearance form shall likewise be used as a documentary requirement in the processing of application for terminal leave pay, for payment of gratuity pay under RA 1616. Further, leave applications with a period of thirty [30) calendar days or more [vacation leave, sick leave, magna carta for women, maternity leave and rehabilitation leave) shall use the same clearance form.

For your i n f o r m ^ n n a£td guidance.

Date

Office Address: National Government Center EDSA, Diliman, Quezon City, Philippines

Telephone Nos.: (02) 929-6071 to 78 Website:www.nia.gov.ph

CS Form No. 7 Series of 2017

Republika ng Pilipinas

( P A M B A N S A N G P A N G A S I W A A N N G PATUBIG) Lungsod ng Quezoji

CLEARANCE FORM (Irtstrvctions at the back)

Telefax No. (632) 928-9343 TIN No. 000-916-415

TO:

Office of Assignment:

Position/SG/Step: Name and Signature of Employee

PURPOSE

Date of Application National Irrigation Administration I hereby apply for clearance from money, property and work-related accountabilities for: Purpose: • Transfer • Resignation • Other Mode of Separation:

• Retirement • Leave Please specify: Effectivity/lnclusive Period:

II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.

Immediate Supervisor Head of Office III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES

Name of Unit/Office/Department Cleared Not Cleared

Name of Clearing Officer/Official Signature

i.Administmtfve Department

a. Human Resources Division MARIA PILIPINAS N. VERZOSA

b. Procurement and Property Division WILHELM S. TIANGCO

c. Office of the Department Manager ATTY. AILYNE C. AGTUCA-SELDA 2. Public Affairs andlnformation Staff

a. Library PiLIPINA P. BERMUDEZ Z. Firiaricial Management Deplartrnerit

a. Acountlng Division ELIZABETH A. BENZON

b. Budget and Revenue Division SYLVIA L. LEANO

c. Cash Division CASIANA C. SALUDAGA

d. Office of the Department Manager EDITHA D. MORALES 4. Agency Accredited Unton/Coooerative. etc.

a. NIAEWPI AITY. AILYNE C. AGTUCA-SELDA

b. NIASLA APOLONIA G. GABERIA

c. NIA-COOP EDEN VICTORIA C. SELVA

d. NIAEASP-NCR WILHELM S. TIANGCO

e. NIAVKBCl

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Legal Services PEPITO L. PADILLA I I with pending administrative case

CD with ongoing investigation (no formal charge yet)

V [ C E R T I F I C A T I O N

MGEN ROMEO G GAN (Ret) Deputy Administrator for Administrative and Finance Sector

Page 1 of 2

gtSTRUCnOMS:

1. EmplGyBes w4io are retiring, being separalBd. fransferring lo other agencies, leaving the Philippines and going on matemity leave of absence shaH prepare this form in quadruplicate.

2. This clearance should be duly accomplished before paying the last salary or any money due the employees. (Specify which type of clearance: maternity leave, retirement, transfer, etc.)

3. If the employees are dearsd from a unit/offioeAiepartment. the dearirig/authorized offictal may attach to this clearance the pertinent document/s that shali prove that the employees are cleared of any ot>ligation or accountalMlity from their office, if any, arxJ tick the box under the "Cleared* column before affbong ttieir signatures.

4. If tt)e employees appear to have uncleared accountabitity/ies from a unit/ofRceAlepartment. the dearing/authorized official shall attach to this deararx^ the pertinent document/s that shaH prove that the employees have remaining otjiigation or aooountabiiity from ttieir office further indicating the r>ecessary action/s that the employee must satisfy in order to be deered. and tick the box under the "Uncleared" column. The dearing/authorized official must only sign this clearance corresponding to ttieir name once tfie empfoyee have complied the necessary requirements and cleared of aH the ot)ligation/s and accourrtabiiity/les from their office. They must srtso tick the txix under the "Cleared" column.

5- The HRMO sfiai distritxite copies of approved clearance as foltows: original to the emptoyee; duplk:ale to be attached to the payroll or voucher, triplicate to human resource unit file; and fourth copy to accounting/auditing office.

6- Processirig of c learafx» certificate shaH follow the order of fHimljer i r K J k » ^

Pttge2af2