BLGF Change Request

Form No. 3

BLGF Change Request Form No. 3:

Correction of Reports on the Utilization of the 20% Internal Revenue Allotment (IRA) for Local
Development Project (LDP) (Fiscal Year 2017)

City/Municipality of : __________________________________ Region :

Province of : __________________________________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS.

(1) Fill out the Form in case of a necessary change/correction of the report.
(2) Request form must be accompanied by supporting documents.

This is to certify that a discrepancy occurred in the Statement of Receipts and Expenditures (SRE) report
submitted through the electronic SRE (eSRE) system for Fiscal Year/s ______. Relative herein, may we request that
these data be changed:

SRE Request for Changes/Correction of the Report, Fiscal Year _____

Expenditure Request for

Submitted SRE report
Change/Correction of Reason/ Justification
in the eSRE system
Report

☐ General Public Services

☐ Education, Culture &
Sports/Manpower
Development
☐ Health, Nutrition &
Population Control
☐ Labor and Employment
☐ Housing and Community
Development
☐ Social Services and Social
Welfare
☐
Economic Services

☐
Debt Service

Certified correct: Noted by:

Provincial/City/Municipal Treasurer Governor or

City/Municipal Mayor

Provincial/City/Municipal Accountant

Provincial/City/Municipal Budget Officer

Date: Date: