Republic of the Philippines

OFFICE OF THE PRESIDENT

Dangerous Drugs Board

Ground Floor, DDB-PDEA Bldg.,

North Square, Bgy. Masinop, Batangas City

April 22, 2022

Date

THE HONORABLE

Undersecretary RINZO MANINGNING

Executive Director

SUBJECT: APPLICATION FOR VOLUNTARY CONFINEMENT FOR TREATMENT AND

REHABILITATION THRU REPRESENTATION

SIR:

I am Cessy Maligaya / Mother of Rence Maligaya , 22 years old , Single , student at

College of Brgy. Maliwanag, Batangas City and a resident of 23 Bilao St. Brgy. Maliwanag,
Batangas City and a victim of drug abuse using cocaine and cannabis. For and in his / her behalf,
I would like to voluntarily submit him/her for confinement for treatment and rehabilitation at
the Matino Rehabilitation Center pursuant Government Accredited Drug Rehabilitation Center
to Section 54, Article VIII of R. A. 9165, otherwise known as the Comprehensive Dangerous
Drugs Act of 2002 and Board Regulation No. 3, S. 2007. This is his / her first time of applying for
voluntary confinement .

I bind myself to obey all of such terms and conditions that may be imposed by the Court,
Board and the Center under pain of being cited in contempt as provided for under Section 73 of
the Act.

For the Board’s favorable consideration.

 CESSY MALIGAYA

Name of Applicant / Representative

Conforme:

CESSY MALIGAYA, MOTHER

(Name and Relation to Drug Dependent)

APPROVED / DISAPPROVED:

Undersecretary RINZO MANINGNING

Executive Director / Duly Authorized DDB Representative

 Republic of the Philippines

OFFICE OF THE PRESIDENT

Dangerous Drugs Board

Ground Floor, DDB-PDEA Bldg.,

North Square, Batangas City

VERIFICATION

I, Cessy Maligaya , Filipino, of legal age, married / single with residence and postal
address at 23 Bilao St. Brgy. Maliwanag, Batangas City after having been duly sworn to in
accordance with law, hereby depose and state:

1. That I am the applicant on behalf of Rence Maligaya , for voluntary confinement for
treatment and rehabilitation under the voluntary submission program of the government
pursuant to Sec.54, Art. VIII of RA 9165, otherwise known as the Comprehensive Dangerous
Drugs Act of 2002 and Board Regulation No. 3, Series of 2007;

2. That I have read and fully understood the contents thereof finding them true and
correct according to my own knowledge, information and belief.

CESSY MALIGAYA

Name and Signature of Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of April 2022 in Brgy. Maliwanag,
Batangas affiant exhibited to his/her CTC No 3954.

NOTARY PUBLIC

Doc. No. 11

Page No. 1
Book No. 23

Series of 2022

APPROVED / DISAPPROVED :

Atty. Linena Uchiha

Duly Authorized DDB Representative