ASSISTANCE FORM

Email *

Phone *

Address (Street, Barangay, Municipality/City) *

How Should We Reach You Out? *

Type of Assistance Needed

Please Upload your VALID ID here (front and back) *

REQUIRED DOCUMENTS

COMPLETELY FILLED & SIGNED Official Assistance Form (CPAC-008)(This Document).

PHOTOCOPY of 1 Valid Government Issued ID with current address & signature for validation.

BARANGAY CERTIFICATION that indicates affected status (e.g., disaster-affected, indigent, etc.)

SUPPORTING DOCUMENTS:

For example:

○ School certificate (for educational aid)

○ Hospital bill (for medical aid)

○ Photos of damage (for calamity aid)

Upload your attachments here *

Description of the Assistance *

PAHIBALO: Ang tabang nga mahatag sa Cebu People’s Action Center (CPAC) limitado lamang sa ilang gi-specified nga scope of assistance. Salamat sa pag-sabot nga dili tanang klase sa hangyo ma-akomodar.

Your Signature Here *

Clear

I hereby certify that the information provided above is true
and correct to the best of my knowledge.