Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

EMPLOYEES’ COMPENSATION COMMISSION
4th& 5th Floors, ECC Building, 355 Sen. Gil J. Puyat Avenue, City of Makati

Tel. No. 899-4251; 899-4252Fax. No. 897-7597E-mail: info@ecc.gov.phWebsite: http://www.ecc.gov.ph

Equipment Handover Form

Additional Items Accompanying the

Item Description Model Color Serial No.
main item?

1 Hewlett-Packard HP ProBook 440 G2 Black 1588-3003 Laptop Bag, Charger, CDs(Windows 8.1,
(HP) Laptop Windows 7 Pro, MS Office 2013, HP
Manual

2 Logitech Pointer R400 Black 60825-1 Pouch

3 Apple Ipad Wi-Fi 128 MP2H2PP/A Space Gray GCTV43VRHLFD Pouch, box
GB

4 Panasonic Charger Ni-MH Charger White BQ-CC18 4 AA Rechargeable Batteries, 2 AAA

Rechargeable Batteries

I hereby acknowledge that upon tendering my resignation, it is with my full intention to hand over and/or endorse the above equipment which I have
received during my assumption of work in Employees’ Compensation Commission – Regional Extension Unit 3 from September to December 5, 2018.

Endorser/Handed over by: FRANCES JEMAINE GONZALES, December 12, 2018

By signing below, I acknowledge that the items handed over are in good and working condition by herein endorser upon her resignation from
Employees’ Compensation Commission. Therefore, Ms. Gonzales is hereby cleared from all duties and responsibilities in REU 3/Central Luzon.

Endorsee/Handed over to: COCO CHANEL GARCIA, December 12, 2018