THE BJMP PROVIDENT FUND

FORM 3

Written Authority to Deduct Membership Fee and Contribution

I,________________________________________, with the rank of

___________________________(if NUP, put NUP instead of rank), is a bona fide member of
the Bureau of Jail Management and Penology and presently assigned at
_________________________________ as ______________________________________.
(designation)

That I have signified through my written manifestation to join voluntarily the BJMP
Provident Fund.

I understand that pursuant to EO 641 dated 25 July 2007, Budget Circular No. 2008-3
dated 20 June 2008, and the By-Laws of the BJMP Provident Fund, membership in the BJMP
Provident Fund constitutes the authority to deduct from the payroll the members’ regular
monetary contribution.

That by virtue of my membership with the BJMP Provident Fund and the issuances
above mentioned, I am authorizing the Finance Office, BJMP National Headquarters, to deduct
from the payroll the following:

One-time membership fee of Two Hundred Fifty Pesos (P250.00)

Monthly monetary contribution of (please check appropriate box)

 One Hundred Pesos (P100.00)  Others ________________ (please specify)

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ___________,
_______, at __________________________

___________________________
Signature Over Printed Name

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