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Form 4: Annex E

(AGENCY LETTERHEAD)

LIST OF BONDED ACCOUNTABLE PUBLIC OFFICER/S

TYPE OF APPLICATION
PREVIOUS YEAR'S DATA
AMOUNT PREFERRED
(Check "ü" the DESIGNATION EFFECTIVITY DATE BOND
NAME OF PUBLIC OFFICER appropriate column) (e.g. Disbursing/ RISK NO. COVERAGE REMARKS (WITH/WITHOUT PENDING
Collecting/Signing From To ADMINISTRATIVE AND CRIMINAL CASE)
Officer) (1, 2, or 3
ACCOUNTABILITY BOND PREMIUM YEARS)
NEW RENEWAL ( For Renewal)

1. CARLITO M. GONZALES Punong Barangay

2. IMELDA E. ALVAREZ Brgy. Treasurer

Prepared by: Reviewed by: Certified and Approved by:

IMELDA E. ALVAREZ WENIFREDA C. GALSIM CARLITO M. GONZALES


Signature over printed name Signature over printed name Name & Designation of Authorized Official
Brgy Treasurer Brgy Secretary Brgy. Captain

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