ANNEX "A-1"

Revenue Region No. ___ - _________

_______________
Date

MEMORANDUM FOR:

____________________
Regional Director
Revenue Region No. ___
____________________

We respectfully request for authority to dispose the following obsolete, damaged

or cancelled accountable forms, which are more specifically described in the attached
Inventory Report of the Committee on Disposal of Specialized Accountable Forms in the
Regional Office, consisting of _____ pages:

BIR FORM QUANTITY REMARKS

Should this request merit your approval, due notice will be given to the
Chairperson of the aforementioned Committee to effect the disposal of said forms in
accordance with existing Commission on Audit rules and regulations.

__________________________
Chief, Administrative and Human
Resource Management Division
Committee Member

Recommending Approval:

__________________________
Asst. Regional Director
Chairperson, Committee on Disposal of
Specialized Accountable Forms

_________________________ _______________________
Chief, Finance Division BIR Regional COA Auditor
Committee Member Committee Witness