REPUBLIC OF THE PHILIPPINES)

…………… ………………………… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, _______________________________________________, of legal age, Filipino,

Married / Single, formerly assigned at _____________________ and with a postal address at
______________________________________________________________ after having
duly sworn to in accordance with law do hereby depose and state:

That, I retired Compulsory/Optionally/TPPD effective ______________________

pursuant to S.O./G.O. Number __________ dated _______________________;

That, prior to my retirement, I have an outstanding Loan Balance from the PNP
Provident Fund/Firearms Accountability/Salary Overpayment amounting to
P____________;

That, in view with the above______________________________________________,

(Loan Balance from PNP Provident Fund/Firearms Accountability/Salary Overpayment)
I am authorizing the Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
REPUBLIC OF THE PHILIPPINES)
…………… ………………………… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, _______________________________________________, of legal age, Filipino,

Married / Single, formerly assigned at _____________________ and with a postal address at
______________________________________________________________ after having
duly sworn to in accordance with law do hereby depose and state:

That, I retired Compulsory/Optionally/TPPD effective ______________________

pursuant to S.O./G.O. Number __________ dated _______________________;

That, prior to my retirement, I have an outstanding Loan Balance from

AFPSLAI/PSSLAI/PSMBFI/AFPMBI or other Financial Institutions amounting to
P____________;

That, in view with the above______________________________________________,

(Loan Balance AFPSLAI/PSSLAI/PSMBFI/AFPMBI or other Financial Institutions)
I am authorizingthe Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
REPUBLIC OF THE PHILIPPINES)
…………… ………………………… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, _______________________________________________, of legal age, Filipino,

Married / Single, formerly assigned at _____________________ and with a postal address at
______________________________________________________________ after having
duly sworn to in accordance with law do hereby depose and state:

That, I retired Compulsory/Optionally/TPPD effective ______________________

pursuant to S.O./G.O. Number __________ dated _______________________;

That, prior to my retirement, I have an outstanding Loan Balance from the PNP
Provident Fund/Firearms Accountability/Salary Overpayment and AFPSLAI/PSSLAI/
PSMBFI/AFPMBI or other Financial Institutions amounting to P____________;

That, in view with the above______________________________________________,

(Accountability Balance from the PNP and other Financial Institutions)
I am authorizing the Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
REPUBLIC OF THE PHILIPPINES)

………….. ………………………… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, ___________________________________________, of legal age, Filipino, Married

/Single, formerly assigned at _____________________ and with a postal address at
______________________________________________________________ after having
duly sworn to in accordance with law do hereby depose and state:

That, I am Resigned/Dismissed/Dropped from Rolls effective

___________________ pursuant to S.O./G.O. Number __________ dated
_______________________;

That, prior to my separation, I have an outstanding Loan Balance from the PNP
Provident Fund/Firearms Accountability/Salary Overpayment amountingto
P____________;

That, in view with the above______________________________________________,

(Loan Balance from PNP Provident Fund/Firearms Accountability/Salary Overpayment)
I am authorizingthe Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
REPUBLIC OF THE PHILIPPINES)
Tacloban City ………………………) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, ____________________________________, of legal age, Filipino, and with a postal

address at ___________________________________________________________
after having duly sworn to in accordance with law do hereby depose and state:

That, I am the legal wife/beneficiary of _____________________________________,

(Name of PNP Personnel)
formerly assigned at __________________________________;

That, __________________________________ Posthumously Retired/Separated

(Name of PNP Personnel)
from the PNP Service effective ___________________ pursuant to S.O./G.O. Number
__________ dated _______________________;

That, prior to his/her separation, he/she has an outstanding Loan Balance from the
PNP Provident Fund/Firearms Accountability/Salary Overpayment amounting to
P____________;

That, in view with the above______________________________________________,

(Loan Balance from PNP Provident Fund/Firearms Accountability/Salary Overpayment)
I am authorizing the Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
REPUBLIC OF THE PHILIPPINES)
………………………… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, ____________________________________, of legal age, Filipino, and with a postal

address at ___________________________________________________________
after having duly sworn to in accordance with law do hereby depose and state:

That, I am the legal wife/beneficiary of _____________________________________,

(Name of PNP Personnel)
formerly assigned at __________________________________;

That, _________________________________________ Compulsorily/Optionally

(Name of PNP Personnel)

Retired/Separated from the PNP Service effective ___________________ pursuant to

S.O./G.O. Number __________ dated _______________________;

That, prior to his/herseparation, he/she has an outstanding Loan Balance from the
PNP Provident Fund/Firearms Accountability/Salary Overpayment amountingto
P____________;

That, in view with the above______________________________________________,

(Loan Balance from PNP Provident Fund/Firearms Accountability/Salary Overpayment)
I am authorizingthe Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
REPUBLIC OF THE PHILIPPINES)
……… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, ____________________________________, of legal age, Filipino, and with a postal

address at ___________________________________________________________
after having duly sworn to in accordance with law do hereby depose and state:

That, I am the legal wife/beneficiary of _____________________________________,

(Name of INP Personnel)
formerly assigned at __________________________________;

That, _________________________________________ Compulsorily/Optionally

(Name of INP Personnel)

Retired/Separated from the PNP Service effective ___________________ pursuant to

S.O./G.O. Number __________ dated _______________________;

That, prior to his/herseparation, he/she has an outstanding Loan Balance from the
PNP Provident Fund/Firearms Accountability/Salary Overpayment amountingto
P____________;

That, in view with the above______________________________________________,

(Loan Balance from PNP Provident Fund/Firearms Accountability/Salary Overpayment)
I am authorizingthe Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of

_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,

20____ at _______________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________