Republic of the Philippines DEAPRTMENT OF EDUCATION GENERAL FORM NO. 57(A) CEBU PROVINCE Risk Number REQUEST FOR BONDING AND/OR CANCELLATION OF BOND OF ACCOUNTABLE OFFICIALS AND EMPLOYEES OF THE REPUBLIC OF THE PHILIPPINES. Fi: NAMIE OF PERSON TO BE BONDED WHOSE BOND 1 TO BE CANCELIED [= DESIGNATION OR TILE OF POSTION surname Given Midaie FE DATE OF INCOMING OFFICER AESUWIES ACCOUNTABIITY Year Month ay fa STATON Municipality Provinee/Ciy 5-AMOUNT OF MANIMUM ACCOUNTABIITYICUSTODY P hen exenter hare fan Ofer’ conto Amount lover tins or pronerty cannot be ferred rm he tle 2) Public Funds or designation given, flan complete statement of (1) As Collecting Officer P utes should be gen above (2) As Disbursing Officer Pr (use sstional set necessary) ») Public roperty [SALARY ATTACHED TO TE POSTION (4) Supplies and Materials Pr (2) Equipment ® P (2) others P incase of temporary appointment o esgaton, €) Forms and Other Valuables alr of permanent and temporary incumbent shoud (4) internal Rev. Stamps e beste) {2) Internal Rev. Doe. Stamps P 7 BOND RECOMENDED {2) Customs Doc. Stamps Pr (3) Postage and Other Stamped Stock P P (5) Science Stamps Pr (5) Cash Tickets r [s-BOND FIED BY TAW OR BY THE CHARAN (others P Commission on avorT TotslAmount: — P P ERSONAL RECORD OF PERSON TO BE BONDED (Use additional or separate sheet if necessary) [(@) CRIMINAL OR ADMINISTRATIVE RECORD [a (A) PREVIOUS EXPERIENCE [IHIS BLOCKED TO BE FILLED ONLY IN CASE OF BOND CANCELLATION) i. PRESENT TITLE OR DESIGNATION 20, NAME OF OFFICER TO BE RELIEVED Sumame Given Middle [12, AMOUNT OF BOND AND RISK NUMBER INFORCE 3. SALARY OF PERSON TO BE RELIEVED 14, DATE OF RELIEF 15. CAUSE OF RELIEF Yeor Month Day fig. REMARKS City Mayor Provincial Treasurer JEREMY C. DENAMPO, ADMINISTRATIVE OFFICER V Head of Agency or Office }