INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, , , In employment status, with a monthly salary of Php. and Salary Grade Level of SG
from commits to deliver and agree to be rated on the attainment of the following targets in accordance with the indicate measures for the period of to

Name of Employee

Reviewed by: Date: Noted by: Date: Approve by: Date: Ratinng Scale:

5 - Outstanding
4 - Very Satisfactory
3 - Satisfactory
HON. JUNARD "AHONG" Q. CHAN 2 - Unsatisfactory
Immediate Supervisor Department Head City Mayor 1 - Poor

RATING
SUCCESS INDICATORS
MFO/FAP ACTUAL ACCOMPLISHMENTS Remarks
(TARGETS + MEASURES)
QN QL T A

Core Functions

DIVISION/SECTION

MAJOR FINAL OUTPUT/SERVICES

1∙ 0

2∙ 0

3∙ 0
4∙ 0

5∙ 0

6∙ 0

OTHR CSC - MANDATED FUNCTIONS

Commitment: IPCR submitted to HRMDO on the ____________of IPCR submitted to HRMDO on the __________________of
IPCR submitted to HRMDO for initaial review __________________ ____________ ____________________ ____________

Rating: Duly rated IPCR submitted to HRMDO on the

Duly rated IPCR submitted to HRMDO on the
___________of___________________________
Duly rated IPCR submitted to HRMDO ___________of___________________________ ________
________

SUPPORT FUNCTIONS(10%)

Attendance to flag raising ceremonies 100% attendance to flag rasing ceremonies 90% attendance to flag ceremonies 3

Attendance to City respondent officail activities 100% attendance officail activities 100% attendance to city inconsired officail activities 4

SUMMARY OF RATING TOTAL: Final Numerical Rating Final Adjectival Rating

Formula:(total of all overage ratings/nas. of

CORE FUNCTIONS: entries) × 90% (70% if there are strategic
functions)

formula:(total of all overage ratings/nas. of

SUPPORT FUNCTIONS:
entries) × 10%

Comments and Recommendations for Development Purposes:

Discussed With: Date: Assessed by: Date: Reviewed by: Date: Reviewed by: Date:

PERFORMANCE MANAGEMENT TEAM HON. JUNARD "AHONG" Q. CHAN

Ratee Rater PMT LCE/SPMS Champion

Legend: On - Quantity Ql - Quality T- Timeliness A - average

 Republic of The Philippines
City Social Welface and Development Office
Lapu-Lapu City, Cebu 6015

NAME NUMBER BARANGAY SIGNATURE

SIGNATURE
 Civil Service Form No. 48 Emp. No. Civil Service Form No. 48 Emp. No.
DAILY TIME RECORD DAILY TIME RECORD

(Name) (Name)
For the Month of_ 2023 For the Month of_
A.M. P.M. A.M.
Official hours for Reg. Day __________ Official hours for Reg. Day __________
Arrival and Departure Week. Day _________ Arrival and Departure Week. Day _________
A.M. P.M. OVERTIME A.M. P.M. OVERTIME
DAYS DAYS
Arrival Depart Arrival Depart Hours MIN. Arrival Depart Arrival Depart Hours
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
TOTAL TOTAL

I CERTIFY on my honor that the above is a true and correct report I CERTIFY on my honor that the above is a true and correct report
of the hours of worked performed record of which was made daily of the hours of worked performed record of which was made daily
at the time of arrival at and departure from the office. at the time of arrival at and departure from the office.
Verified as to the presence office hours Verified as to the presence office hours

LOUIE DE LOS SANTOS LOUIE DE LOS SANTOS

OFFICE IN-CHARGE OFFICE IN-CHARGE
 Emp. No.
RD

2023
P.M.
. Day __________
ek. Day _________
OVERTIME
MIN.

a true and correct report

of which was made daily
m the office.
office hours

GE
 SWORN STATEMENT OF ASSET, LIABILITIES AND NET WORTH

As Of
( Required by R.A. 6713 )

Note: Husband and Wife are both public officials and employees may fil the required statements jiontly or separately
Jiont Filing Separate Filing Not Applicable

DECLARANT: POSITION:
( Family Name ) ( First Name ) ( M.I. ) AGENCY/OFFICE:
ADDRESS: OFFICE ADDRESS:

SPOUSE: POSITION:
( Family Name ) ( First Name ) ( M.I. ) AGENCY/OFFICE:
OFFICE ADDRESS:

UNMARIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD

NAME DATE OF BIRTH AGE

ASSETS, LIABILITIES AND NETWORTH

( Including those of the spouse and unmaried children below eighteen (18)
years of age living in declarant's household )
1. Assets

a. Real Properties*

DESCRIPTION KIND LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION Cost

( e.g. lot, house and lot ( e.g. residincial, VALUE MARKET VALUE
condominium and

improvements ) agricultural and mixed ( As found in the Tax Declaration of

YEAR MODE
use ) Real Property )

Subtotal:
b. Personal
Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

Subtotal:
TOTAL ASSETS ( a + b ). ___________________________

2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES: NET WORTH:

Total Assets Lees Total Liabilities =

Page 1 of ____
 * Additional sheet/s may be used, if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

( of Declarant's spouse/Unmarried Children Below Eighteen (18) years of age Living in Declarant's Household )

I /We do not have any business interest or financial coonestion.

NAME OF ENTITY/BUSINESS ADDRESS BUSINESS ADDRESS NATURE OF BUSINESS INTERIST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR CONNECTION

I hereby certify that these are true and correct statemants of my assets, liabilities, net worth, business interest and financial connections,
including those of my spouse and unmarried children below eighteen (18) years of age living in my household, and that best of my knowledge, the
above - enumerated are names of my relatives in the government within the fourth civil degree of consanguinity or affinity.

I hereby authorize the Ombudsman or his/her duly authorized representative to obtain and secure from all appropriate government agencies,
including the Bureau of Internal Revenue such documents that may show my assets, liabilities, net worth, businees interest and financial connectios, to
include those of my spouse and unmarried children below 18 years of age living with me in my household covering previous years to include the year I
first assumed office in government.

Date:

( Signature of Declarant ) ( Signature of Co - Declarant/Spouse )

Government Issued ID: Government Issued ID:

ID No: ID No:

Date Issued: Date Issued:

SUBSCRIBE AND SWORN to before me this _____ day of ______ affiant exhibiting to me the above - stated goverment issued identification card.

( Person Administrative Oath )

Page 2 of _____
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