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Republic of the Philippines

CIVIL SERVICE COMMISSION


Regional Office No. VIII
Government Center, Palo, Leyte

_______________________
Date

CIVIL SERVICE COMMISSION

Subject: Request for Certificate of No Pending Administrative Case

Sir/Madam:

May I respectfully request your good office to issue Certificate of No Pending


Administrative Case in my favor which shall be used for the purpose/s indicated below:

a. _____ promotion
b. _____ retirement
mandatory ____
optional ____
c. _____ other (please specify) ________________________________.

Moreover, I likewise attest that no pending case is filed against me before my agency.

Your immediate attention on this matter will be greatly appreciated.

Very truly yours,

________________________________
Signature

To be filled up by CSC Personnel


________________________________
Last Name First Name M.I.
PALD - Received by: __________________
Date : __________________ ________________________________
Time: Address

________________________________
Present Position
LSD
Date received : _______________ ________________________________
Time received : _______________ Name of Agency/Address
Verified by: __________________

Payment for Certificate of No Pending Release:


Administrative Case = Php100.00
CASHIER Received by : _____________________
Date : Date : _____________________
O.R. No.
Time: _______________ Time : _____________________
Date & Time _______________
Issued by _______________

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