DSWD-RLA Form 3

Republic of the Philippines

Department of Social Welfare and Development

APPLICATION FOR ACCREDITATION OF

SOCIAL WELFARE AND DEVELOPMENT AGENCIES

Date: April 22, 2019

Type of Application : Status of Application: Mode of Service Delivery:

(Please check the appropriate box)
 DSWD New Application  Residential Based
 LGU  Renewal  Community Based
 Private SWDA DSWD Previously Issued

 SWD Network Certificate No: SB- A-2024-2018

 Resource Agency Date of Issuance: October 22, 2018
Providing Direct Services Date of Expiration: Sept 17, 2022

I. Identifying Information:
1. Name of Agency:
San Lorenzo Ruiz Charity (SJDMC), Inc.
. .
_________________________________
_________________________________
3. Agency Head
Balbuena A. Ornedo .
4. Position Title/Designation:
Executive Director
6. E-mail Address:
slrcharity@yahoo.com
7. Registration/Permit No:
71. SEC No: CN200415342 . 8.1 SEC Issued: September 30, 2004
7.2. CDA No. ____________________
7.3. Mayor’s Permit No. 757
7.4. DSWD Reg. Lic
SB-RL-00209-2018
2. Business Address:
G. Medel St., Brgy. Kanluran
(No., Street/Subdivision, Barangay)
Calauan .
(Municipality/City)
Laguna .
(Province)
5.Telephone/Mobile/Fax Numbers
. (044)769-15-68/(049)5037251 .
7.Website:
. www.sanlorenzoruizcharity.org .
8. Date of Issuance of Registration/Permit
.
8.2. CDA Issued: ________________________
8.3. Mayor’s Permit Issued: January 10, 2019
8.4. DSWD Reg. & Lic Issued. Oct. 22, 2018

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II. Specific Objectives of the Agency (pls. state):

1. Create opportunities for the development and enhancement of spiritual and moral values of people
towards community concern for others, especially those who have less in life.

2. Provide social welfare services to poor families and individuals giving priorities to those who are
in need of educational assistance (scholarship), medical services, disaster victims, individuals and
crisis situations as well as those in need of livelihood/economic advancement support and;

3. Mobilize and maximize the active participation of other sectors in the community here and abroad,
to support this noble cause of uplifting the living conditions of the poor thru their donations,
pledges, commitments, sponsorship, program fund raising and other ways of resource generation.

III. Program Profile (Please indicate all the programs and services for implementation/operation
and/or being implemented/operated by the applying SWDA):
Area of
Target Clientele
Coverage/Location (Please check the appropriate column)
Type of (pls. specify)
Programs and

VictimsDisasters

Others (Specify)
ProvinceCity/

Munici-pality

Older Person

Commu-nity
Services per
Children

Women
Region

Family
Youth

PWD
Service Delivery
Mode

1.Direct Program/s (pls. specify all the programs and services that is directly provided to the clientele per area of operation)
a. Community-based

1. Scholars  

2. Supplemental
  
Feeding

3. Daycare   

b. Residential-based (pls. indicate specific name of each facility and services provided to the clientele)
IV. Personnel (current year)
No and Composition Technical Staff Administrative Staff Registered Community
of Staff Complement Social Worker Development Worker
Full time/
3 2 - -
Regular Staff
Part time Staff - - - -
Volunteer Staff - - - -

V. Budget 2018:

1. Annual Budget (Latest): 991,512.15

2. Source of Funds: (Please specify the SWDA’s specific sources of funds whether government
or private organizations/individuals, local and/or international/foreign including other resource
generation activities with the corresponding amount of funds in peso value.)

a. Local Source Peso Value

Budget Allotment 990,000.00

Bank Interest 558.15
Refund - tardiness 954.00

Total 991,512.15

b. Foreign Source Peso Value

_________________________________ _____________________
_________________________________ _____________________

I hereby certify that the information on this application form is true and complete.

BALBUENA A. ORNEDO
(Signature Over Printed Name of the Agency Head or Authorized Representative)

EXECUTIVE DIRECTOR
(Position/Designation of the Agency Head or Authorized Representative)

4-22-2019
(Date)