HRDS-PAD
Form No. 01
(Revised, March 2015) / CLEARANCE FROM
MONEY / PROPERTY / OTHER ACCOUNTABILITIES /
PART I: EMPLOYEE’S DATA
Printed Name
and Signature: ______
Complete Maiden Name (For married female employee) :
______
Employee Number: ______
Position: ______
Status of Appointment: ______
Office/Division: ______/ PART II: PURPOSE

PART III: This certifies that above employee is cleared
A.  EMPLOYEE’S OFFICE
As to reports required:
______
Date Immediate Chief
______
Date Head of Office / D.  FINANCIAL AND MANAGEMENT SERVICE
As to financial accountability as follows:
Account Code / Account Title / Analyst’s Initials
1-01-01-010 / Cash-Collecting Officer
1-01-01-020 / Petty Cash Fund
1-03-05-010 / Receivables-Disallowances/Charges
1-03-05-020 / Due from Officers and Employees
1-03-05-990 / Other Receivables
1-99-01-010 / Advances for Operating Expenses
1-99-01-020 / Advances for Payroll
1-99-01-030 / Advances to Special Disbursing Officer
1-99-01-040 / Advances to Officers and Employees
Remarks:
______RICHELDA L. BALLAD
Date Chief, Accounting Division
Noted by:
______NENITA O. GARCIA
Date Director IV, FMS
B.  ADMINISTRATIVE SERVICE
As to property accountability:
______MA. VICTORIA E. MARQUEZ
Date Chief, Property Division
As to records accountability:
______LILY PEARL L. GUERRERO
Date Chief, General Services Division
As to money accountability:
______
Date Chief, Cash Division
Noted by:
______VIOLETA N. MUÑOZ
Date Director IV, AS
C.  HUMAN RESOURCE DEVELOPMENT SERVICE
As to personnel matters:
______EVANGELINE Q. QUINOY
Date Chief, Personnel Administration Division
As to training matters:
______
Date Chief, Staff Development Division
Noted by:
______KATHERINE B. BRIMON
Date Director IV, HRDS / E.  LIBRARY
As to books/periodicals borrowed:
______MARIA TERESA M. CABANCE
Date Department Librarian
F.  COOPERATIVE/DOLE-OEA
As to credit/financial obligations:
______
Date Treasurer, DOLEEC, Inc.
______
Date Treasurer, DOLE-OEA
______
Date Treasurer, DOLE-EU
PART III-G.
AS TO ADMINISTRATIVE CASE PER AO 253, S. 2009:
______REBECCA C. CHATO
Date Undersecretary / PART IV: APPROVED
______
Date
NOTE: In case of regional office personnel, duly accomplished regional clearance is a pre-requisite for this Department Clearance. Approval of this Clearance shall not preclude filing of succeeding claims.