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Clearance

Please put N/A for each entry that does not apply to you. * Required Fields
Purpose of Clearance *
Description Quantity
Processing Fee: PHP 150
Appointment
Awards(Specify Name)
Bar Exam
Bidding Requirements
CDD
CES Eligibility
CESO Rank
Change of Name (Specify Name)
Commissionship
Completion of Residency Training
Confirmation
Court Requirement
Death Claim
Disability Retirement
Discharge
Dropped from Roll
Employment
End of Contract (Specify Date)
End of Term (Specify Date)
Expiration of Appointment
Expiration of Term
Extension of Service
Fidelity Bond
Firearm License
Foreign Assignment
Foreign Travel
Free and Accepted Masonry
GSIS Claim
Grant of Benefits, unrelated to the preceding purpose
Guarantorship
Lateral Entry
Leave Application
Loan Application
Nomination
Permit to Carry Firearms
Promotion
Rationalization
Reappointment
Recognition
Reemployment
Requirement by JBC, CSC, CESB, Office of the President, PRC, GOCC, DFA, DOLE, BI, LTO, NBI, PNP & other agencies. Specify Agency
Resignation (Specify Date)
Retirement (Specify Date)
Reversion
SUC Presidency
Scholarship
Schooling
Scientific Career System
Separation (Specify Date)
Study Grant
TPPD
Transfer
UN Mission
VISA

Payment and Release *
Mode of Payment : *
Fill this up if you are paying by Cash/PMO. All aplications paid thru SM will be automatically delivered via private courier.
Mode of Release : *
Central Office: Office of the Ombudsman, OMB Building Agham Road, North Triangle Diliman, Quezon City 1101
OMB Visayas: Office of the Ombudsman for the Visayas, Department of Agriculture RO-7 Compound M. Velez St., Guadalupe, 6000 Cebu City
OMB Mindanao: Office of the Ombudsman for Mindanao, Libra Street corner Earth Street, GSIS Heights, Matina, Davao City
Applicant‘s mailing address is located in: *

Employment Details *
Current Position: *:
Name of Company: *:
Office Address: *:

Information Sheet *
First Name: *
Middle Name: *
Last Name: *:
Suffix:
If Married, Mother's Maiden Surname:
Date of birth *:
Address: *:
Gender*
Date of Marriage
Civil Status*
Previous Address:
Contact #:
Email *:
Delivery Address*

Educational Background *
School Attended * Date of Attendance * Degrees Earned *
Elementary *
Highschool *
College / University *
Vocational
Post Graduate
Highest Educational Attainment: *
Employment History
Government History
Name of Office Address Position Inclusive Dates
Private Sector
Name of Office Address Position Inclusive Dates
Name of Requester:
Relation to the deceased, in case of death claim:
*I declare under the penalties of perjury that the answers given above are true & correct to the best of my knowledge and belief. *
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