PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN
(GOVERNMENT SERVICE INSURANCE SYSTEM)
Financial Center, Pasay City, Metro Manila 1308
GSIS SCHOLARSHIP PROGRAM 2010-2011
DESIGNATION OF SCHOLAR
_____________________________________________________________________
WINNER’S LAST NAME FIRST NAME MIDDLE NAME
______________________________ ____________________________________
NAME OF OFFICE ADDRESS OF AGENCY
with GSIS ID No. _______________ do hereby designate;
FULL NAME OF SCHOLAR DATE OF COURSE/SCHOOL RELATIONSHIP
BIRTH ENROLLED IN TO THE WINNER
to be my chosen beneficiary of the scholarship grant given by the GSIS under its
Scholarship Program for SY 2010-2011.
Done this ______ day of ______________ 2010.
_______________________ _____________________________________
MEMBER - WINNER AGENCY ADMINISTRATIVE OFFICER
(Signature over Printed Name) (Signature over Printed Name)
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CERTIFICATION
This is to certify that the Designation of Scholar has been received by this office and
validated/authenticated against submitted documents as required by the Scholarship
Program.
Done on ____________ 2010 at ___________________________.
(Day-Month) (GSIS Office)
________________________
Manager, Office/Unit