Republic of the Philippines

Regional Trial Court

7th Judicial Region
Lapu-Lapu City
Branch 69

CERTIFICATION
FOR MONEY AND/ OR PROPERTY
ACCOUNTABILITY/ NON-ACCOUNTABILITY

I hereby certify that_______________________________________,

____________________________________, of _____________________
____________________________________:

a.____________________________money and/ or property accountability;

b.____________________________been appointed or designated as
ACCOUNTABLE OFFICER in the Office of the Clerk of Court to handle
financial transaction of the court; (if employee had been so appointed/ designated,
sate the period of designation)_______________________________________;
and

c._______________________________ unliquidated cash advance/s received

pursuant to paragraphs 2, 3 and 4, Sec. 10 of Rule 141 of the Revised Rules of
Court; Specifically the One Thousand Pesos (Php 1,000.00) deposit to defray the
actual travel expenses in the service of summons and other court processes, and (2)
the cash deposit of interested party litigants for other expenses such as execution of
writs, safeguarding of the property, and the like.

This certification is being issued as one of the documentary requirements in

the processing of the Supreme Court clearance by the Office of the Court
Administrator.

Issued this__________day of_______________.

_____________________
(Branch Clerk of Court/ Designated Branch
Officer-In-Charge)

Noted:
_____________________
(Presiding Judge)