RErUf3L1C OF rut PlllLlrrlNES

rH I Ll r r IN E STA T 1STle S A UT H 0 RI TY

PSA-CTCO-15Reference No. 15H$D01-744

December 22, 2015

HON. LlSA GRACE S. BERSALES, Ph.D.National StatisticianThis Office

Thru: JOSIE B. PEREZDeputy National StatisticianCensuses and Technical Coordination Office

Dear Madam:

This is to report to your good office the status of my graduate studies at theUniversity of the Philippines, Diliman, Quezon City under the program of Master ofArts in Demography. I was enrolled during the first semester of AY 2011-2012 forthesis writing. I already made a thesis proposal on "The Association BetweenDomestic Violence and Selected Reproductive Health Outcomes in Mindanao" topicand defended successfully. The paper is a work in progress and needs updating. Inline with this, I would like to ask permission to take a study leave during the secondsemester AY 2015-2016, which would be inclusive in the months of January to May2016, to concentrate on the completion and defense of my thesis.

I hope for your understanding and unwavering support.

Respectfully yours,

TEODORO M. ORTEZAStatistical Specialist 11, PHCD

171h I: Eton Ccntris Cyberpod 3 EDSA cor Quezon Avenue, Diliman Quezon CityTelephone: 376-1903 Telet'ax: 376-1834

PSA - CTCO-15Reference No. 15HSD01-745

POPULATION AND HOUSING CENSUS DIVISION

1sI EndorsementDecember 22,2015

Respectfully forwarded to Minerva Eloisa P. Esquivias, Assistant National Statisticianof National Censuses Service the letter of Mr. Teodoro M. Orteza for NationalStatistician Lisa Grace S. Bersales, Ph.D., signifying his intention to finish the thesisin the second semester of AY 2015 - 2016.

MAR~~ALUYOTOIC, PHCD

·' .Reference NO.10GAD02-0830~

SUPPLEMENTAL CONTRACTLocal Scholarship Contract

Re: TEODORO M. ORTEZA

Pursuant to Local Scholarship Service Contract executed between the National Statistics Office(NSO) represented by Administrator CARMEUTA N. ERICTA, and scholarship grantee, Mr. Teodoro M.Orteza dated May 19, 2009, the parties have hereby agreed to the following amendment/supplementalprovisions as follows:

1. That the scholarship grantee, Teodoro M. Orteza, shall be granted an extension to pursue theMaster of Arts in Demography at the University of the Philippines Population Institute fromJune 14 to March 31, 2011;

2. That the grantee shall serve the NSO an additional service obligation of two (2) years as perSection 2 of E. O. 367 covering the period of one year extension;

3. That the grantee's total service obligation to NSO in connection with the study grant of theMaster of Arts in Demography is four (4) years commencing immediately upon his return towork on April 4, 2011 until April 4, 2015. Any discontinuity in the service rendered during thesaid duration shall be charged against the leave credits of the grantee;

4. That the grantee shall receive additional value of the fellowship as follows:Salaries. Other Emoluments and Adjustments P 214,466.00

The amount stated above may be subject to change depending on the actual amountreceived by the GRANTEE. Such actual amount shall be calculated at the end of the periodof the original and/or supplemental contract, whichever is later, or at the time the occurrenceof a breach, if applicable; and

5. The same terms and conditions of the contract referred to above shall apply. Specifically,failure of the GRANTEE to fulfill the terms and conditions of the contract shall make him/herliable to refund to his/her Office all amounts actually defrayed for the whole duration of thestudy grant.

The Supplemental Contract is hereby made an integral and amendatory part of the contractreferred to above.

NATIONAL STATISTICS OFFICE

Ck..~}/r~-CARMELlTA'"if. ERICTA

Administratoy~

.~TEODORO M. ORTEZA

Grantee

NATIONALSTATISIlI...'> ·.Jtr-l<.·.

CERTIFfED TRUE (,,('11''1'

k.cA.- ,L--k~MEIJI NOREEN O. CENTENO

Guarantor

71t.df~

MAR Y ROSE A BRILLCADMJNJSTRATIVI! OFF/CEi<"

~IJI RtSClUU !I4~e •••r~''''M!o'''''

2Iz. 1bA.t-.lG -.:--1\....•...'" s.,. kllltim''fj<..1 !;:\\~i).

s.1>rtJ t<C61A1:: ~ MA-i(,.\ K.{0}. c.,fr't

SIGNED IN THE P~SENCE OF:

ffil'~M"~ - wu:.PAU~~v~~;G. COLLADO

Chairman, P~rsonnel Development Committee (PDC)

..

SOd~7.ABEJOMember, PDC

nir~~tnr of tha Gr~nt~~

FIEL/~:~ROMe~lfe~~~~c

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )M A NIL A ) S.S.

BEFORE ME, this day of , __ in the Municipality of___________ , Philippines, personally appeared Carmelita N. Ericta, withCommunity Tax No. 22094118 issued at Manila on January 12. 2010, TEODORO M.ORTEZA, with Community Tax No. 15772691j- issued at Han; la on February 3, 2010

respectively, known to me to be the same person who executed the foregoing instrument andthey acknowledged to me that the same is their free act and deed.

IN WITNESS WHEREOF, I have hereunto set my hands this day of

NOTARY PUBLIC

Doc. No. _PageNo. _Book No _Series of _

'\IA flONAL STATISTICS OFHCE

CERTTFfEn TRUE COpy

~\.1. ",'. ~ ;, r:.):: r ; 8FaLLO; ,)V:.'';;:; ,,/ :'-,-: 1: (lFFlCER V

....•. ,0 \'1~/:?Jt'{,."I~'''' T);""si.

SCHOLARSHIP SERVICE CONTRACT

KNOW ALL MEN BY THESE PRESENTS:

This contract is entered into by an between:

The .Government of the Philippines, through the National Statistics Officerepresented by Administrator CARMELlTA N. ERICTA with principal office at SolicarelBldg. I, R. Magsaysay Blvd., Sta. Mesa, Manila, hereinafter referred to as theGRANTOR;

-and-

TEODORO M. ORTEZA ,of legal age, Filipino, single/married residing atLot 1 Blk. 16 Phase 2 Monte Oro Subdivision, San Isidro, Antipolo City, Rizal, hereinaftercalled the GRANTEE;

-and-

ANALlSA T. PIAD of legal age, Filipino, Single/married residing at Blk. 14 Lot 8Juana 3B Biiian, Laguna 4024, hereinafter called the GUARANTOR;

J I WITNESSETH:

Pursuant to the provisions of E.O. 129 as amended, and in consideration of thegrant and acceptance by the GRANTEE of a scholarship award to undergo, on officialtime, a program entitled Master of Arts in Demographv (M.A. Demography) at theUniversity of the Philippines from June 2, 2009 to May 31, 2010, the GRANTEE herebyagrees to fulfill the following terms and conditions:

1. This Contract shall be in effect for the duration of the scholarship, continuingto that period covered in Section 10. .

2. The GRANTEE shall keep up with standards of the scholarship award.

3. The GRANTEE shall have a guarantor who should be a eo-worker,provided that the annual salary of such co-worker is equal to or morethan the annual salary of the GRANTEE. The Guarantor shall assumefull monetary responsibility as set out in Section 10, jointly andseverally, should the GRANTEE fail to comply with the conditions setforth;

4. The GRANTEE shall conduct him/herself in such a manner as not to bringdisgrace or dishonor to himself or herself, and/or his/her country /office;

5. At the end of each term, the GRANTEE shall submit to the head of his Officehis official transcript of grades, certificate of performance or its equivalent;

6. If there is sufficient reason for the extension of the original scholarship award,the GRANTEE shall submit a formal request to his/her agency for suchextension, along with a justification and recommendation from his/herprogram adviser. Such request and supporting documents must be

1

submitted six (6) months prior to the expiration of the office order. Theapproval of the extension shall be made upon the recommendation ofPersonnel Development Committee to the head of the Agency and upon theGRANTEE's execution of a supplementary scholarship contract covering theextension period;

7. Upon the completion or termination of his/her scholarship, fellowship grant,, the GRANTEE shall report to the National Statistics Office.

8. The GRANTEE shall submit to the GRANTOR, and other concerned offices acompletion report on his/her scholarship within sixty (60) days after his/herreturn of duty.

9. Should the GRANTEE transfer to another government agency during theduration of this contract, he/she shall, be considered in breach of this contractand shall be liable to pay the amount due as stated in Section 12, withoutprejudice to any llabtllty resultinq from any other action the NSO may takebecause of the breach.

10. That the GRANTEE shall serve the National Statistics Office for a period ofTwo (2) years as per Section 2 of E.O. 367, and any other pertinent law atthe time the contract was signed.

11. That the GRANTEE accepts the value of the fellowships as follows:a. Transportation P $

(GOP, Local & International)b. Tuition Fees and other fees P $ _c. Allowances from the GOP and Sponsor

Clothing P $Subsistence P $Establishment P $ -----Books P $

Miscellaneous P $Pro-departure Expense P $ -----

d. Salaries, Other Emoluments &any Adjustments made on theremuneration or other benefft the

~ATIOwAL S·TAll$T1(;!r. Of'rCe GRANTEE may have actuallynan Resouree M8na~'t Civ'kftwceive from GOP(+bonus +PERA) P 203,096.00 $ _

CertifIed tru(,iPh~'C'~ from(Ile ongilT!

tb-Total ** P 203,096.00 $

OAfS .• , ADLAWANAdministrat;w Of1icer V

** Amounts stated above are preliminary and may change dependingon the ectuet amount received by the GRANTEE

12. Breach of contract is defined as the failure to comply with the terms andconditions of this contract through the following instances:

a. Willful neglect;b. Resignation, transfer of office, or any other torrn of voluntary

separation from service with the NSO;c. Any cause within the control of the GRANTEE;

2

d. Any other instance not otherwise mentioned or contemplated in ,theabove-mentioned circumstances but which results in the failure of theGRANTEE to fulfill the terms and conditions of this contract.

IN WITNESS THEREOF, we have hereunder set our hands this ~ dayof ~1Aj ;/))j) " at Manila, Philippines.

~'E-CARMELlTA N. ICTA

~ad of AgencyTEODORO M. ORTEZA

Grant-ee

~PIADGuarantor

Blk. 14 Lot 8 Juana3B Birian, Laquna 4024

Address

Signed in the Presence of:-p~~~

PAUL~ MdNI~A G. COLLADOChairman, Personnel Development Committee

ftN 1\ /I;.. rN I UTvv. rri->'

ROSALlNDA P. BAUTISTADirector of the Grantee

3

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINESMANILA

I

S.S.

BEFORE ME, this /c1fi1 day of Mtt'j ,2tcc.) in the Municipality ofI\'JItNI LA , Philippines, personally appeared Ms. Carmelita N.

Ericta, with Residence Certificate No. 27011061 issued at Manila on Feb. 27. 2009 ;TEODORO M. ORTEZA with Residence Certificate No. 2801365.5 issued at AntipoloCity. Rizal on February 23. 2009 respectively, known to me to be the same personwho executed the foregoing instrument and they ack owledged to me that t e same istheir free act and deed.

In WITNESS WHEREOF,fil\J\A t ' M1>1\

day of

Doc. No. _-"E:.-7"--_Page No. --4g~--Book No. _-:!-'f....!..!IV__Series of -=~~1+-," "'--_

4

Page 1 of 1

Delivered-To: d.adlawan@psa.gov.phX-Virus-Scanned: amavisd-new at psa.gov.phAuthentication-Results: rnx.census.gov.ph (amavisd-new);

dkim=pass (2048-bit key) header.d=yahoo.comDKIM-Signature: v=1; a=rsa-sha256; c=relaxedlrelaxed; d=yahoo.com; s=s2048; t=1452222765; bh=fkjOHUUBizm575W35jK1sy20pZEiBC06jI12WReCslc=;h=Date:From:Reply- To:To:Cc:Subject:References:From:Subject;b=WlNzT +yOAEHKzQBTIorqCyg60S+/SOVCtvVZlgv3LtfasMnWVX6hBAhDK9bOweaWMrrqc+iblsugkBTqpyOW+VIIOmlW3Ws 74T gppk7jSUelx3XVWr1 MIYXxqFX-Yahoo-Newman-Property: yrnail-3X-Yahoo-Newman-Id: 298296.93606.bm@omp1013.mail.sg3.yahoo.comX-YMail-OSG: UaSyDZYVM1 m6yod4haRtV1 SbHOgsOTXvhGsK80YUHOUVKOnHFh1 mTkSn TaaOgEiZJuMTEPs3zROIOdZH_ G65_6Y .OWleVTku_d1 OalbOaOTN1 mlXmwoAxsSbv202gvbPpgaGhOOgiuhNrqOazEXRkCW_.gs Tpr40J8kfUJsKyMcg6SdLsP .K9IUMJBdUhR4zxDhGz6E.32Y1 H03RcsgLsKKsYhp6WU_DDx61PTnuOvdXtmfjRnOcDc9Tz8xM3SfOXvQYrKOV9sBIMa01q4.FOMI5ezm3OCAg_JjowycG3zCTu8CaihetPPAtlkGqRnMZGpA. T1 Wk2UB20RvXmwotObfCwUwXRvVcjakf6Z4mH3Mxlp72.oMhyXT1 DwpANTwzOELgSr4JOvEv2AjkfuNYDm6UZgzji70tqROTo 73WtbhuzBMcLoo2w _Y7r8Ji9HNoWFa2DMCGj9iHfmmCrxR55V8sd12MOROAEZVoXfmk2s2EnWMR4AgFCexl5qSx17 _7Uh20JrVg8RMfxWrDate: Fri, 8 Jan 2016 03:12:44 +0000 (UTC)From: Teddy Orteza <teddycom23@yahoo.com>Reply-To: Teddy Orteza <teddycom23@yahoo.com>To: "m.brillo@psa.gov.ph" <m.brillo@psa.gov.ph>Cc: "D.Adlawan@psa.gov.ph" <D.Adlawan@psa.gov.ph>Subject: Study Leave DurationX-Antivirus: AVG for E-mail 2016.0.7303 [4489/11349]X-AVG-ID: 1D42A54FS-A1DE88D

DeerMaam.

In ccnnedion wi1h my approved study leave. I wood like to request that 1he wmtion of my ~ study leave conlrad to sIart Cfl JanJory 11. 2016 and will end on J\.ne 10. 2016.

Thank you very "'-'ch.

Teodoro M. O1ezaStatistidan 11.PHCD

No virus found in this message.Checked by AVG - www.avg.comVersion: 2016.0.7303/ Virus Database: 4489/11349 - Release Date: 01107/16

file:1 Ile :/windows/system32/configlSYSTEM~ 11AppData/Local/Temp/eudD .htm 118/2016