Republic of the Philippines

Province of ____________
DEPARTMENT OF EDUCATION
Schools Division Office of ________
_______________________

__________________________________________
Schools Division Superintendent
Schools Division Office of ____________
______________________________
x-----------------------------------------------x

ADMINISTRATIVE COMPLAINT
The undersigned ______________________ accuses _______________________, a Teacher of _________________
Elementary School with I.D. No. ________________________ of Conduct Unbecoming a Public School Teacher
and Dishonesty penalized under R.A. 6713 – Code of Conduct and Ethical Standards for Public Officials
and Employees and under the Administrative Code , committed as follows:

1. That on May 1. 2010 in the Municipality of _________________, ______________, ________________________

entered into a Contract of Loan of Forty Thousand Pesos (Php 40,000.00) with the undersigned and made
a Promissory to pay on December 2010. Attached herewith is an Acknowledgement Receipt marked as
EXHIBIT “A” and made as integral part hereof.

2. That before May 1, 2010. ________________________, who was my fellow teacher assigned at
_________________ Elementary School, while I was then in _______________________, came to me and she
represented to me that her sister is going to go abroad for Canada, but they needed money to finance her
expenses. _____________________ asked for a loan from me and pleaded that she will pay the loan as soon as
her sister arrived in Canada.

3. That ________________ sister left for Canada, but up to now she failed and refused to pay me her
loan despite my repeated demands.

4. I was convinced to give her that loan because she assured me that if her sister will be able to go
to Canada, she will be able to find a work there and she, ________________, will pay me immediately. If she
did not make such representation to me, I would not have given her that loan. I was deceived and she lied
to me. She was dishonest and deceitful, a conduct unbecoming of a Teacher.

5. I am filing administrative complaint against her. I will also file necessary criminal complaint
against her in the proper agency for Estafa.

Done this November 21, 2016 at San Juan, Abra.

________________________________
Complainant
WITNESSES:
__________________________ ________________________________

Copy furnished:

1. Gaudelia S. Barbosa 2. Mr. Ronald B. Castillo, CESO VI – Schools Div. Sup.

3. Mr. Artemio L. Lazo – Lam-ag Elem. School Principal

SWORN TO before me this __________day of _________________20_____ at Bangued, Abra, Philippines. I

FURTHER CERTIFY, that I have personally examined the affiant and found out that she voluntarily his
statement and understood its contents.